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The Health Insurance Portability and Accountability Act (HIPAA) mandated
the adoption and use of a standard identifier called the National Provider
Identifier (NPI) for all health care providers to be used in electronic
transactions. NPI will be required on paper transactions only in those
states where this is mandated, such as Minnesota. This standard identifier
will replace the current Medicare identifiers (UPIN and OSCAR numbers)
and Health Plan proprietary provider numbers for standard EDI transactions.
HIPAA requires that covered entities (i.e., health plans, health care
clearinghouses, pharmacies, and health care providers) that transmit any
health information in an electronic HIPAA format, use NPI in transactions
by the compliance date of May 23, 2007, with a compliance date of May
23. 2008 for small health plans.
On April 2, 2007 the Centers for Medicare & Medicaid Services (CMS)
announced that it is implementing a contingency plan for covered entities
(other than small health plans) who will not meet the May 23, 2007, deadline
for compliance with the National Provider Identifier (NPI) regulations
under the Health Insurance Portability and Accountability Act (HIPAA)
of 1996. For a 12 month period after the compliance date (i.e., through
May 23, 2008), CMS will not impose penalties on covered entities that
deploy contingency plans.
Uniprise NPI Update:
- The NPI application period began on May 23, 2005. Click
here for more information on the application process from the
National Plan and Provider Enumeration System.
- UnitedHealthcare has taken the necessary precautions
to ensure that systems are able to “process without disruption” if an
electronic claim transaction is received with an NPI prior to the May
23, 2007 compliance date. This means that an NPI is disregarded if received
on a transaction and the systems will continue to process the transaction
based on the primary identifier.
- UnitedHealthcare began
collecting NPI information in January 2006 and is storing it internally.
- UnitedHealthcare will have the ability to download NPI
data from the National Provider and Plan System (NPPES) into internal
provider databases. This process will be defined upon completion of
the CMS “Data Dissemination” notice.
- To assist our trading partners, Uniprise developed companion
documents to describe the company-specific details for HIPAA transactions,
including the usage of NPI. The Uniprise companion documents contain
supplementary instructions for the HIPAA implementation guides. These
companion documents do not replace or modify the HIPAA implementation
guides, but should be used in conjunction with them (the HIPAA implementation
guides can be found at www.wpc-edi.com).
- The National Uniform Claim Committee (NUCC) and the National
Uniform Billing Committee (NUBC) have released modified versions of
the current professional and facility claim forms. Among the changes
will be the inclusion of NPI data fields. The revised claim forms and
critical transition and effective dates are:
- The transition from the CMS 1500 to the 1500
HICF (Health Insurance Claim Form) is October 1, 2006 with
a mandatory compliance date of April 1, 2007.
- The transition from the UB92 to the UB04
Form is from March 1, 2007 with a mandatory compliance date
of May 23, 2007.
- UnitedHealthcare has made a business decision to initially
accept transactions sent to us without NPI or with incorrect NPI to
ensure uninterrupted quality service to our providers and our members.
Furthermore, we will not reject transactions that contain other legacy
identifiers in addition to NPI. We are considering a timeframe in which
we will reject transactions that come in without NPI.
- UnitedHealthcare and Its Affiliates are working towards a timeframe
in which we will not accept HIPAA transactions that require an NPI,
but are received without an NPI or with an invalid NPI. The goal is
to be in full-compliance on or before May 23, 2008. Any changes to our
current policy for accepting transactions without NPI will be preceded
with communications to physicians, health care professionals, organizations
and trading partners regarding when we expect to begin to not accept
HIPAA transactions that do not contain a valid NPI in the fields specified
by the Implementation Guide. Refer to the UnitedHealthcare and Its
Affiliates NPI Contingency Plan below:
UnitedHealthcare NPI Policy for
Trading Partners (.doc file)
UnitedHealthcare and Its Affiliates
NPI Contingency Plan (.pdf file)
Related Links:
Centers
for Medicare & Medicaid Services FAQs
CMS
News for Medicare Fee for Service Providers
This
material is provided on the recipient's agreement that it will only be used
for the purpose of describing Uniprise products and services to the recipient.
Any other use, copying or distribution without the express written permission
of Uniprise is prohibited. - 04/25/07
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