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National Provider Identifier (NPI)Frequently asked questionsGeneral NPI informationWhat is a National Provider Identifier (NPI)? Is a health care provider required to obtain an NPI? Why do health care providers need NPIs? How can health care providers obtain an NPI? How many NPIs do health care providers need? What is my Primary Provider Taxonomy Code? How long will it take to receive an NPI? How can health care providers report NPIs to Independence Blue Cross (IBC)? Where can I obtain additional information on the National Provider Identifier? EnumerationClaims/BillingWhere are the IBC billing instructions and companion guides? What happens if a claim comes in without an NPI? Will IBC allow providers to bill legacy and/or NPI after May 23, 2008? Will IBC require NPIs on paper claims after May 23, 2008? Will IBC require Tax ID in addition to NPI on paper claims? Is IBC planning on requiring a nine-digit zip code on the claim form? Payer ReadinessDoes IBC currently require different NPIs when there are different provider numbers? When will IBC start processing standard transactions with NPIs? How can hospitals notify IBC of their NPIs? What happens in IBC’s system if an invalid NPI is received in any provider field? Does IBC plan to give providers access to their NPI(s) in provider directories? Are NPIs required when using the interactive voice response (IVR) system? General NPI informationWhat is a National Provider Identifier (NPI)? NPIs replace health care provider identifiers used for standard transactions under the Health Insurance Portability and Accountability Act (HIPAA). Those numbers included payer-specific IDs and Medicare legacy IDs (e.g., UPIN, OSCAR, PIN, and National Supplier Clearinghouse). A provider’s NPI will not change. It will remain with the provider regardless of job or location change(s). Is a health care provider required to obtain an NPI? Why do health care providers need NPIs? NPIs allow for simpler electronic transmission of HIPAA standard transactions. After May 23, 2008, the NPI will be the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities. Covered entities include health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard. NPIs are being used to identify health care providers on prescriptions and in internal files to link proprietary provider identification numbers and other information, coordination of benefits between health plans, patient medical record systems, program integrity files, and other ways as well. How can health care providers obtain an NPI?
How many NPIs do health care providers need? A sole proprietor/sole proprietorship is eligible for a single NPI. A sole proprietor/sole proprietorship cannot have subparts and cannot designate subparts. In terms of NPI assignment, a sole proprietor/sole proprietorship is an Entity Type 1 (Individual). Organizations must also apply for a single NPI. In terms of NPI assignment, organization health care providers who are covered entities under HIPAA must apply for NPIs as Entity Type 2 (organization). Organization health care providers are corporations/partnerships or other types of businesses that are considered separate from an individual by the state in which they exist. Subparts of such organization health care providers who apply for NPIs are also Entity Type 2.
What is my Primary Provider Taxonomy Code? How long will it take to receive an NPI?
CMS estimates that, in general, a health care provider who submits a properly completed, electronic application could have an NPI within ten days. How can health care providers report NPIs to Independence Blue Cross (IBC)? Participating providers may also register their NPI(s) with us by mailing their completed custom NPI submission form. This form has been included in mailings to participating provider offices. Contact your Network Coordinator with questions regarding the new Provider Registration web form or your custom NPI submission form. Where can I obtain additional information on the National Provider Identifier? EnumerationHow do I enumerate? Claims/BillingWhat are the significant dates associated with applying for and using an NPI on electronic and paper claims? 837(I) and 837(P) Electronic Claim Forms: IBC began accepting NPIs along with your legacy IDs on January 1, 2007. Beginning May 23, 2008, IBC will only accept your claims using your NPI(s). CMS-1500, UB-04, UB-92 Paper Claim Forms: The professional and institutional paper claim forms (CMS-1500 and UB-92) have been revised to allow NPIs to be included. As of April 2007, CMS requires all health care providers to obtain and use their NPIs, regardless of the submission method. IBC no longer accepts paper claims submitted on forms CMS-1500 (12/90) and UB-92. All paper claims must be submitted on revised forms CMS-1500 (08/05) and UB-04. Paper claims submitted on forms CMS-1500 (12/90) and UB-92 will reject. Where are the IBC billing instructions and companion guides? What happens if a claim comes in without an NPI? Will IBC allow providers to bill legacy and/or NPI after May 23, 2008? For purposes of processing a claim in accordance with the reimbursement terms of your IBC provider contract, you may continue to provide your ten-digit legacy ID number in addition to your valid, registered NPI. The sole purpose for providing the ten-digit legacy ID number is to facilitate accurate claims payment — not to identify the claim for acceptance into IBC’s system. Only a valid NPI will be accepted by IBC as the primary identifier on the claim. Will IBC require NPIs on paper claims after May 23, 2008? Will IBC require Tax ID in addition to NPI on paper claims? If IBC is requiring NPI on all provider fields, will claims be denied/rejected if an NPI is not provided for ordering and/or referring providers? Some of these providers may not have an NPI, and others we may not be able to obtain.
Is IBC planning on requiring a nine-digit zip code on the claim form? If providers choose to enumerate their subparts further than they currently have today with payer legacy ID numbers, will IBC require enrollment of their additional subparts? Payer ReadinessDoes IBC require different NPIs when there are currently different provider numbers? When will IBC start processing standard transactions with NPIs? How can hospitals notify IBC of their NPIs? Contact your Network Coordinator with questions regarding the new Provider Registration Web Form. Does IBC plan to validate [meet CMS NPI formula] and verify [Dr. Smith’s NPI is truly Dr. Smith’s] provider NPI(s)? What happens in IBC’s system if an invalid NPI is received in any provider field?
Does IBC plan to give providers access to NPIs in provider directories? Are NPIs required when using the interactive voice response (IVR) system? |