NPI and Electronic Claims:
An Update on Unprepared Carriers
According to CMS's published NPI timeline, effective May 23, 2008, they will accept only the NPI on all HIPAA electronic claims and send only the NPI on all paper remittances. This applies to both rendering and referring providers identified on the claims. The actual implementation of this final step will differ among the various carriers according to the readiness of their respective systems. For those carriers that may still temporarily accept NPI / legacy number combinations on claims, it is imperative that they be able to establish a cross-walk between the two identifiers.
PSA has been submitting test files using NPI numbers, without legacy information, to payors who are prepared, and correcting NPI Crosswalk issues for affiliated practices by editing provider's NPI profiles.
Please be aware that when carriers say they are ready to accept only the NPI on all electronic claims, this might not actually be true. We have already discovered that GA BCBS, KY BCBS and IN BCBS all stated they were ready for NPI only, but when we submitted the NPI only in the required fields, the claims rejected. This resulted in our having to change the electronic format back to include legacy numbers again, causing delays in payment.
When applying for an NPI, a provider supplies legacy information to NPPES, the NPI enumerator, that is used by the carriers as the cross-reference verification. To ensure that legacy numbers are listed correctly on the Registry, PSA is reviewing all doctors' profiles for whom we have user name / password information. If PSA initially submitted your NPI application, your user name and password are on file. If you (or your representative) applied for your NPI independently of PSA, please submit your log-on info by emailing tcanup@psapath.com or faxing it to 843-269-2199. This is a secure e-fax number.
Also, when checking the NPI Registry to view your profile, please be aware that changes may not be immediately reflected and only a limited number of legacy numbers are displayed at any time.