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Payors will begin requiring the use of individual National Provider Identifiers (NPI) on all HIPAA standard transactions that are currently in use and identify you as a provider.
The Crozer-Keystone NPI Resource Center is your guide to the following information:
About NPI
How to Comply
How to Apply for Your NPI Number
How to Submit Your NPI Number to Crozer-Keystone Health System
How to View Crozer-Keystone Health System's NPI Numbers
Important Updates from CMS: New Information!
- New! June 19: Medicare FFS NPI Update & Part B Issues Identified
- May 23: National Provider (NPI) News for Medicare FFS Providers: It's May 22nd - Are You Ready?
- May 8, 2008: Additional Guidance and Clarification for Identifying Secondary Providers in Medicare Claims
- April 28, 2008: Important Information for Medicare FFS Providers. May 7 is "Legacy Free" Day.
April 4, 2008: Time-sensitive information...May 23, 2008 deadline... avoid disruption in cash flow. (Click 'Important Updates from CMS' link.)
If you’ve already obtained your individual, 10-digit NPI number, please complete the form in the link below to securely submit it to the Crozer-Keystone Health System.
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About NPI
Read the Press Release from CMS: "CMS Clarifies Guidelines for National Provider Identifier (NPI) Deadline Implementation
Read the FAQs: CMS has posted new NPI FAQs related to the NPI Compliance Contingency Guidance on its website. You can view these FAQs by going to the CMS dedicated NPI web page and scrolling down to the section that says, "Related Links Inside CMS" and clicking on NPI Frequently Asked Questions. To find the latest FAQs, click on the arrows next to "Date Updated."
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How to Comply
To help physicians comply with this new requirement, Crozer-Keystone Health System offers physicians the following:
- A link to apply for your NPI number if you haven't already done so (below)
- A secure form (link is below) to submit NPI numbers to the health care system for physicians who have already obtained NPI numbers
- A listing of CKHS' NPI numbers (pdf below)
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How to Apply for Your NPI Number
Apply here.
How to Submit Your NPI Number to Crozer-Keystone Health System
Physicians, if you have already obtained your individual, 10-digit NPI number, please complete the form in the link below to securely submit it to the Crozer-Keystone Health System. Thank you.
NPI Collection Form (Form is secure.)
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How to View Crozer-Keystone Health System NPI Numbers
Reference Crozer-Keystone Health System's NPI numbers in the link below.
CKHS NPI Numbers (pdf)
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Important Updates
Click on the links below for more information about important updates.
New! June 19, 2008: Medicare FFS NPI Update & Part B Issues Identified
May 23, 2008: National Provider (NPI) News for Medicare FFS Providers: It's May 22nd - Are You Ready?
May 8, 2008: Additional Guidance and Clarification for Identifying Secondary Providers in Medicare Claims
April 28, 2008: Important Information for Medicare FFS Providers. May 7 is "Legacy Free" Day.
April 4, 2008: Information for all Health Care Providers Medicare & Non-Medicare: Understanding the Readiness of Other Health Plans, Steps to Facilitate a Smooth Transition to NPI-Only Medicare Billing and More
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New! Medicare FFS NPI Update & Part B Issues Identified
As of 5/23/08, the National Provider Identifier (NPI) became mandatory on all HIPAA claims transactions and on Medicare paper transactions as well. All transactions must be submitted with the NPI in fields requiring a provider identifier (see items 1-3 below concerning the reporting of the Taxpayer Identification Number (TIN)). The Centers for Medicare & Medicaid Services (CMS) continues to see progress with NPI compliance and most Medicare contractors are reporting over 95 percent of claims contain only NPI. However, for some of the relatively few claims which continue to reject, we have determined that some of the reasons are related to the following issues identified for Part B claims:
1) The Employer Identification Number (EIN) or Social Security Number (SSN) being submitted in the 2010AA / REF02 (Billing Provider Secondary Identifier), 2010AB / REF02 (Pay to Provider Secondary Identifier) and/or 2310B / REF02 (Rendering Provider Secondary Identifier) of the Medicare X12N 837P transaction does not match the TIN information on the Medicare crosswalk.
2) While EIN or SSN is not required to be submitted in the 2310B loop for Medicare claims, if submitted, the appropriate qualifier must be submitted in the 2310B / REF01.
3) The Medicare legacy provider identifier is being submitted in the primary and/or secondary provider loops. Legacy provider numbers are no longer allowed on ANY Medicare claim or transaction. If sent, the claim or transaction will reject.
Medicare providers should review this list and take appropriate actions to resolve problems they may be experiencing. As a result, providers may decide to stop sending non-required segments, such as the TIN in 2310B/REF02 of the X12N 837P transaction. Providers may also want to consult their clearinghouses or software vendors for additional advice to solve the issues listed in this message.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
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May 23: National Provider (NPI) News for Medicare FFS Providers: It's May 22nd - Are You Ready?
As of May 23, Medicare FFS will require and send NPI-Only in ALL provider identifier fields for all HIPAA and paper transactions where a provider identifier is required. If you send Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your claim will be rejected. These transactions include all electronic and paper claims (837I, 837P, NCPDP, DDE and paper CMS-1500 and UB-04), the 276/277 claims status transaction, the 270/271 eligibility transaction, 835 remittance advice and SPR paper remittance.
NPIs for Secondary Providers
If the entity that is required to be identified in the secondary provider field (i.e., the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber) does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim. The billing provider may use the NPI Registry (https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.
do) to obtain the secondary provider’s NPI or it may need to directly contact the ordering/referring/attending/operating/supervising/purchased service/other/service facility or prescriber in order to obtain the NPI.
· If the billing provider has exhausted all possibilities of finding the NPI of the ordering/referring/attending/operating/supervising/
purchased service/other or prescriber, Medicare FFS is permitting the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) to use their own NPI as the identifier for those secondary providers. Medicare will reject claims if Medicare policy requires a secondary identifier and there is no NPI present.
· For service facility location loop, if the billing provider is still unable to obtain the NPI of the entity, no identifier should be reported in that loop.
Transcript for April 17th NPI Roundtable Now Available
View the transcript at http://www.cms.hhs.gov/NationalProvIdentStand/
Downloads/Transcript_for_April_17th_NPI_Roundtable.pdf on the CMS website.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS web page.
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Additional Guidance and Clarification for Identifying Secondary Providers in Medicare Claims
In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring /attending/operating/
supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) or for prescriber (in the NCPDP 5.1 retail drug claim transaction), that identifier must be an NPI. For Medicare purposes, this requirement is effective May 23, 2008. If the entity to be identified as the ordering/referring/attending/operating/supervising
/purchased service/other/service facility provider or prescriber does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the ordering/referring/ attending/operating/supervising/purchased service/other/service facility or presciber in order to obtain the NPI. While the Implementation guides for the X12N claims transactions permit the reporting of the Social Security Number (SSN) for some secondary providers if there is no NPI, we do not believe the billing provider will be successful in the obtaining the SSN.
If unable to obtain the NPI of the entity to be identified in the service facility location loop, no identifier should be reported in that loop.
If unable to obtain the NPI of the Ordering/referring/attending/operating/supervising
/purchased service/other or prescriber, the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) shall use its own NPI to identify those secondary providers. Medicare will not pay these claims if these secondary providers are not identified by NPIs.
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CMS will Host NPI National Roundtable Q&A Session on May 19, 2008
CMS will host a national NPI Roundtable Q&A session to address questions from the Medicare provider community prior to May 23rd. This Roundtable will be on May 19th from 2-3:30PM EDT.
Questions will not be collected during the registration process for this call. There will be no presentations during this call; we will open the lines to take questions following a brief introduction. For registration details, visit (http://www.cms.hhs.gov/NationalProvIdentStand/
Downloads/listserv_wording_5-19-08_call.pdf) on the CMS website.
REMINDER: CMS will Host NPI National Roundtable on May 14, 2008
Registration is still open for the Roundtable to be held on May 14th from 2-3:30PM EDT. Providers will be able to submit questions through the online registration system at the time of sign up for this call. Similar to the most recent NPI Roundtable, Subject Matter Experts will create presentations based on the questions submitted. For registration details, visit (http://www.cms.hhs.gov/NationalProvIdentStand
/Downloads/listserv_wording_5-14-08_call.pdf) the CMS website.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page (www.cms.hhs.gov/NationalProvIdentStand) on the CMS website. Providers can apply for an NPI online at (https://nppes.cms.hhs.gov) or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
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Important Update (4/28/08) National Provider Identification (NPI): Important Information for Medicare FFS Providers. May 7 is "Legacy Free" Day.
May 7 is “Legacy Free” Day – An opportunity to check your NPI readiness!
CMS, in collaboration with the Healthcare Information and Management Systems Society (HIMSS), has requested clearinghouses that submit claims to FFS Medicare to participate in a one day NPI preparation exercise. Specifically, on Wednesday, May 7, 2008, participating clearinghouses should submit Medicare claims with NPI-only in all provider identifier fields for which a provider uses NPI/legacy pairs. On May 8th, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs as received from the providers.
Through its monthly NPI messages, CMS has been requesting providers to begin testing NPI-only by sending a group of claims with NPI alone in primary provider fields. This “exercise” will result in feedback from your Medicare contractor on your readiness as it pertains to your National Provider Identifiers.
On May 7, 2008, participating clearinghouses will send Medicare claims with NPI-only in provider fields which originally contain NPI/legacy pairs from the provider. In other words, clearinghouses will strip the legacy identifiers when they are submitted as part of an NPI/legacy pair. Of course, fields already containing NPI-only will be sent to Medicare, as usual, and secondary provider identifier fields containing legacy-only will be sent to Medicare, as usual.
This exercise will help Medicare providers evaluate their NPI readiness prior to the May 23, 2008 deadline.
The outcomes of this exercise are described below:
Or
Again, on May 8, 2008, participating clearinghouses will revert back to sending Medicare NPI/legacy pairs, if sent to them by the provider.
Participating clearinghouses will be soon notifying provider clients about details so pay close attention to Clearinghouse communications.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
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Important Update (4/3/08) National Provider Identification (NPI): Understanding the Readiness of Other Health Plans, Steps to Facilitate a Smooth Transition to NPI-Only Medicare Billing and More
Information for all Health Care Providers Medicare & Non-Medicare
CMS encourages all health care providers to ensure they understand the readiness of other health plans with which they interact, especially if those health plans may be primary or secondary to Medicare. Medicare will only accept/send NPI-only transactions beginning May 23rd and providers need to understand from these other plans what will happen if they are unable to send/receive NPI-only transactions.
Important Information for Medicare FFS Providers
CMS is pleased to announce that Medicare is receiving more than 98% of claims with an NPI. The next milestone - May 23rd- requires providers to take the next step so they do not risk disruption in cash flow. Begin billing with NPI-only now to test how May 23rd will impact you.
CMS is concerned that the percentage of Medicare claims with NPI-only is not growing fast enough.
Steps to Facilitate a Smooth Transition to NPI-Only
- Bill with Medicare legacy ID & NPI
- Once claims are successfully processed, move to Step 2.
- Bill with NPI –Only
- Start with a small batch of claims. If, or when, the results are positive, begin sending a greater volume and move to Step 3.
Billing with NPI-only also tests the ability to receive the NPI on 835 transactions.
- Bill with NPI –Only Test NPI-Only on Other HIPAA Transactions
- CMS will require use of the NPI on the 270/271, 276/277 and NCPDP transactions. Providers should begin testing the use of the NPI on these transactions, in small quantities, prior to May 23rd to ensure a smooth transition. Also, be prepared to accept the NPI-only on the 835 remittance advice transaction.
Institutional Providers Submitting Taxonomy Codes to Identify Subparts –
UPDATE: Medicare is Using Alternative Data to Obtain NPI/OSCAR Match
On January 1, 2007, Medicare implemented change request (CR) 5243, which required the submission of taxonomy codes all claims submitted by institutional Medicare providers who submit claims for their primary facility and its subparts (such as psychiatric unit, rehabilitation unit, etc.).
The intent of CR 5243 was to enable Medicare to appropriately crosswalk a provider NPI to each of the provider's subparts through the reporting of taxonomy codes in the claims. Medicare has found that using taxonomy codes has been unsuccessful in obtaining a one-to-one match on the crosswalk for those providers having one NPI tied to multiple OSCAR/Certification numbers. As a result, the taxonomy code is no longer used as part of the crosswalk criteria that are used to attempt to match an NPI with an OSCAR/Certification Number. Currently, the fiscal intermediary shared system (FISS) uses these matching criteria to obtain a one-to-one match between an institutional Medicare provider’s NPI and its OSCAR/Certification Number:
First level of match: Type of bill (TOB) to OSCAR/Certification Number
If the system is unable to identify a valid match, the search will continue with the next level of match.
Second level of match: Revenue code to OSCAR/Certification Number
If the system is unable to identify a valid match, the search will continue with the next level of match.
Third and final level of match: Facility ZIP code on the claim This final level prompts the systems logic to limit the list of appropriate OSCAR numbers by matching the facility ZIP code on the claim against the ZIP code of the master address in the FISS provider address file.
Note: If the system is unable to make a valid match, the claim will suspend with reason code 32105, and the provider will receive an additional development letter (ADR) requesting the OSCAR number.
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Action Required by Institutional Providers with Subparts
Providers are strongly encouraged to enumerate their subparts. The following documents may assist providers in answering additional questions on this subject.
CMS Medicare Subpart Expectations paper may be accessed on the CMS Web site at http://www.cms.hhs.gov/NationalProvIdentStand/
Downloads/Medsubparts01252006.pdf
Read NPI Fact Sheet titled “For Health Care Providers Who are Organizations” at http://www.cms.hhs.gov/NationalProvIdentStand/
Downloads/NPI_FactSheet_Org_Provi_web_07-03-07.pdf
Review the article titled “Information Regarding National Plan and Provider Enumeration System Errors, Using the NPI on Medicare Claims and 835 Remittance Advice Changes” available in the August 2007 Medicare A Bulletin at http://www.floridamedicare.com/Part_A/
Medicare_A_Bulletins/Archive/110043.pdf
Review Special Edition article http://www.cms.hhs.gov/MLNMattersArticles/
downloads/SE0608.pdf
National Plan and Provider Enumeration System (NPPES) https://nppes.cms.hhs.gov/NPPES.
Encourage Clearinghouses to Allow Testing of NPI-Only
It has come to CMS’ attention that some clearinghouses may not allow important NPI-only testing prior to May 23rd. CMS encourages Medicare providers to work with their clearinghouses to allow use of the NPI-only to facilitate this testing. If you do not test, you will not be aware, in advance, of any problems that could prohibit Medicare from processing and paying claims.
Registration Available for NPI Roundtable
CMS subject matter experts will be available to address questions from the provider community on April 17, 2008 from 2-3:30PM ET. Participants are able to submit questions using the online registration system for this call. To register, visit http://www.cms.hhs.gov/NationalProvIdentStand/
Downloads/listserv_wording_4-10-08_call.pdf on the CMS website.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
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Important Update (5/25/07): CMS to Publish the National Plan and Provider Enumeration System (NPPES) Data Dissemination Notice(This notice is from Highmark Medical Services.)
On May 30, CMS will publish the NPPES Data Dissemination Notice that describes the policy by which CMS will make certain NPPES health care provider data available to covered entities under the Health Insurance Portability and Accountability Act (HIPAA) and to others. The health care provider data that are required to be disclosed under the Freedom of Information Act (FOIA) will be made publicly available on June 28.
The FOIA-disclosable data will be made available in an initial file downloadable from the Internet, with monthly update files also downloadable from the Internet, and in a query-only database whereby users can query by NPI or provider name.
The Notice encourages health care providers who have been assigned NPIs to review their NPPES data at this time and make any necessary updates or corrections prior to the end of the 30-day period to ensure that their information is accurate when disclosed by CMS. (Health care providers who are covered entities under HIPAA are required by regulation to update their NPPES data within 30 days of any change.)
The Notice states that health care providers who wish to delete any NPPES data that was not required to be furnished in order to obtain an NPI may do so prior to the end of the 30-day period if they prefer that those data not be disclosed by CMS.
An advance copy of the Notice is available at this link.
Important Update: CMS Issues Contingency Plan
The Centers for Medicare and Medicaid Services (CMS) has issued a contingency plan for National Provider Identifiers (NPI). Previously, CMS had announced that on May 23, payors would begin requiring the use of individual NPI numbers on all HIPAA standard transactions that are in use and identify you as a provider.
For an update on the contingency plan, refer to the following:
Read "Guidance on Compliance with the HIPAA NPI Rule" (after the May 23, 2007 implementation deadline) (pdf)
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