CCNV 2ND ANNUAL CLIENT CONFERNCE

NATIONAL PROVIDER IDENTIFIER AND YOUR

ACCOUNTS RECEIVABLE

Diane Harris 10/16/06

DISCUSSION

Getting started National Provider Identifier (NPI) Tips Preparing your billing staff for NPI

UNDERSTAND HOW THE INTRODUCTION OF A NATIONAL IDENTIFICATION NUMBER FOR ALL PROVIDERS OF MEDICAL SERVICES WILL IMPACT YOUR FACILITY

COMMUNICATE WITH HEALTH PLANS OUTSIDE OF THE CCNV NETWORK TO DETERMINE THEIR NPI IMPLEMENTATION GUIDELINES

THE NPI IS REQUIRED FOR ALL PROVIDERS OF MEDICAL SERVICES

LOCUM TENENS AND CONTRACT PROVIDERS WHO PROVIDE MEDICAL SERVICES AT YOUR FACILITY WILL BE REQUIRED TO PRESENT THEIR INDIVIDUAL NPI’S

YOUR BILLING STAFF WILL NEED TO KNOW WHAT TO DO IF ANOTHER PROVIDER’S NPI IS NEEDED AND IS UNKNOWN (e.g., referred services)

SUGGESTION: COMPILE YOUR REFERRING PHYSICIAN NPI’S SOONER THAN LATER

NPI’S WILL BE USED FOR ALL BILLING TRANSACTIONS• ALL MEDICARE PRODUCTS• ALL MEDICAID PRODUCTS• ALL COMMERCIAL PRODUCTS

CLAIMS WILL BE REJECTED• EFFECTIVE 5/23/07 WITHOUT NPI’S • REJECTION CODE WILL BE: 16

INDICATING THE CLAIM LACKS INFORMATION THAT IS NEEDED FOR ADJUDICATION

IF YOU ARE CURRENTLY RECEIVING MULTIPLE REMITTANCES FROM CARRIERS DUE TO MULTIPLE PROVIDER ID’S THIS WILL CEASE WITH THE NPI

CMS RECOMMENDS RECEIVING YOUR FUNDS ELECTRONICALLY VIA ELECTRONIC FUND TRANSFER OR EFT. THIS IS THE CURRENT TREND WITH MOST MAJOR CARRIERS

COMPANION TECHNOLOGIES IS IN THE PROCESS OF UPDATING YOUR SOFTWARE PROGRAMMING FOR THE NEW 1500 FORM (8/05) AND THE NEW UB FORM (04) TO INCLUDE ELECTRONIC SUBMISSION

ECLINICAL WILL ALSO BE PREPARED FOR THE NEW HIPPA FORMAT PRIOR TO 5/23/07• THE 1500 FORM (8/05) IS READY AND ON

SALE• THE MEDICAID FORM IS READY AND IN

USE• THE UB FORM (04) IS NOT YET READY FOR

RELEASE

CONTINUE TO USE BOTH YOUR LEGACY NUMBERS AND NPI NUMBERS ON CLAIMS UNTIL 5/23/07. THIS WILL ALLOW THE CROSS WALK OF DATA TO OCCUR FOR YOUR FACILITY

CREATE A PROCESS TO SHARE YOUR NPI’S WITH BUSINESS PARTNERS FOR BILLING PURPOSES(HOSPITALS, E-

PRESCRIBING, SKILLED NURSING FACILITIES)

1500 FORM

UB

04

PREPARATION IS THE KEY TO SUCCESS WITH THE NPI AND YOUR AR!

THIS IS A NEW PROCESS FOR INSURANCE CARRIERS, PROVIDERS AND SOFTWARE VENDORS, ARE YOU READY?