Connecting the Dots ... Federal Tax ID to NPI Type 2 and Pharmacy NCPDP

Presented by HQ MEDCOM UBO Programs & Compliance Analyst, Patient Administration Division, Health Policy and Services, Army Medical Department

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28 August 2012 0800-0900 EDT30 August 2012 1400-1500 EDT

Learn why the Organizational National Provider Identifier, (NPI Type 2) and NCPDP Provider ID are linked to the facility Tax ID Number (TIN), Legal Business Name (LBN) and Mailing Address.

Learn how to update the information on file with the IRS.

Learn how to update Facility NPI Type 2 data in the National Plan and Provider Enumeration System (NPPES).

Learn how to request Pharmacy NPI Type 2 and NCPDP Provider ID updates.

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Objectives

Centers for Medicare & Medicaid Services (CMS) requires a TIN to obtain an NPI Type 2 for your Medical Facility.

CMS requires the LBN of the NPI Type 2 match the LBN of the TIN.

This also applies when outlying clinics and pharmacies enumerated with the Parent Facility TIN.

CMS/NPPES does TIN/LBN verification checks with the IRS to verify the enumerated entity exists.

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Why Facility NPI Type 2 Is Linked to TIN

NCPDP Provider ID requirements changed when NPI requirement was implemented.

Pharmacies are required to have an NPI Type 2. As with facility NPI Type 2, CMS requires the LBN of the

Pharmacy NPI Type 2 match the LBN of the TIN. The TMA Pharmacy Operations Center (TMA POC) enumerated

all DoD Pharmacies.

NCPDP requires the LBN of the NCPDP Provider ID match the LBN of the TIN. An IRS TIN Verification Letter is required to be appended to each

NCPDP Provider ID in the NCPDP database. NCPDP uses the IRS TIN Verification Letter to validate TIN and

LBN.

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Why Pharmacy NPI Type 2 and NCPDP Are Linked to TIN

The LBN and mailing address used for the Facility and Pharmacy NPI Type 2, NCPDP Provider ID, and on the medical claim form must match what the IRS has in their database for the TIN. IRS updates can be made:

By letter when changing LBN (sample letter included). By letter or IRS Form 8822-B when just changing mailing address.

The IRS Form 8822-B provides the address to send the form to based on the facility location.

IRS Form 8822-B can be found on the IRS Website: http://www.irs.gov.

IRS TIN Verification letter can be obtained: By calling 1-800-829-0115 or 1-877-829-5500. By written request. Use appropriate address from the 8822-B.

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Tax ID Number

LETTERHEAD

 

MTF NAME [DATE]

ATTN [OFFICE SYMBOL]

STREET ADDRES

CITY STATE ZIP

 

DEPARTMENT OF THE TREASURY

INTERNAL REVENUE SERVICE CENTER

CINCINNATI OH 45999-0023 OR OGDEN UT 84201-0023

 

Re: EIN/TIN [##-#######]

 

Internal Revenue Service,

 

Request the [legal business name and/or address] for US [Service] Military Treatment Facility [Name], EIN/TIN [##-#######] be changed:

 

From: [OLD NAME]

[OLD ADDRESS]

[OLD CITY STATE ZIP]

To: [NEW NAME]

[NEW ADDRESS]

[NEW CITY STATE ZIP]

[NEW NAME] is a (501(c)(1) Exempt Organization - Instrumentality of the United States. Request a letter of verification be sent to this facility upon completion of these requested updates.

 

If you have any issues, questions or concerns, please contact me at [Point of contact information].

 

Sincerely,

  SIGNATURE BLOCK OF POC

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Sample Letter to IRS

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IRS Form 8822-B

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Example of an IRS Verification Letter

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Updating NPI Type 2 – Facility

The easiest and fastest way to update your Facility NPI Type 2 is on-line at https://NPPES.CMS.HHS.GOV If you don’t have a user name and password, you can

create one. You will need:

The NPI Type 2, Organization Name as listed in NPPES, EIN(TIN) used to obtain NPI Type 2.

If you don’t know if on-line access has been created, please contact your Service UBO Representative.

NPPES Screen Shots included on slides 16-20.

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NPIs Type 2 Matching TIN

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Updating Pharmacy NPI Type 2 and NCPDP Provider ID

The TMA Pharmacy Operations Center (TMA POC) is solely responsible for the enumeration and management of DoD Pharmacy Identifiers NPI Type 2 and NCPDP Provider IDs.

When changes are made to LBN and/or mailing address the TMA POC needs to be notified and provided the new IRS TIN Verification Letter.

Provide the new letter, NPI Type 2 and NCPDP Provider ID that requires updating to your Service UBO Representative who will in-turn provide to the TMA POC.

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Pharmacy NPI Type 2 and NCPDP Matching TIN

The Legal Business Name (LBN) and Tax ID Number (TIN) used in NPPES for Facility and Pharmacy NPI Type 2 must match the IRS LBN and TIN.

The LBN and TIN used in NCPDP for Pharmacy NCPDP Provider ID must match the IRS LBN and TIN.

Ensure IRS information is up-to-date and make changes as

needed.

Ensure NPI Type 2 and NCPDP Provider ID information is updated to match IRS information.

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Summary

Questions and Review

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Tax ID Number (TIN) and Employer ID Number (EIN) are interchangeable.

The National Plan and Provider Enumeration System (NPPES) was developed by the Centers for Medicare and Medicaid Services (CMS) to assign the National Provider Identifier (NPI) to eligible health care providers. - CMS uses NPPES to enumerate and maintain information on all providers who

have been enumerated. - NPI is a 10-digit number used to identify:

Type 1: Individuals who render health care or provide atypical services, or furnish health care supplies to patients; e.g., physicians, dentists, nurses, chiropractors, pharmacists, physical therapists, nurse practitioners, physician assistances, etc.

Type 2: Organizations that render health care services, or furnish health care supplies to patients; e.g., hospitals, home health agencies, ambulance companies, health maintenance organizations, durable medical equipment suppliers, pharmacies, dental clinics, etc.

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Additional Information – TIN and NPPES

NCPDP - National Council for Prescription Drug Programs is both a an Organization and a National Pharmacy Provider Identifier. - NCPDP is a not-for-profit, ANSI-accredited*, Standards Development

Organization. NCPDP creates and promotes data interchange standards for the pharmacy services sector of the healthcare industry. NCPDP also provides information and resources that educate the industry. The standards are continually revised and updated to meet the ever-changing healthcare environment. These changes to the standards are reflected by the version of each standard.

- The NCPDP Provider Identification Number (NCPDP Provider ID) formerly known as the NABP number, was developed over twenty-five years ago to provide pharmacies with a unique, national identifier that would assist pharmacies in their interactions with pharmacy payers and claims processors. The NCPDP Provider ID is a seven-digit numbering system that is assigned to every licensed pharmacy and qualified Non-Pharmacy Dispensing Sites (NPDS) in the United States.

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Additional Information-NCPDP

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National Plan & Provider Enumeration System (NPPES)

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National Plan & Provider Enumeration System (NPPES)

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NPPES – Creating Login for Existing NPI

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NPPES - Registry

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NPPES – Organizational NPI Type 2 Look-up

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