NPI NUMBER
By May 23, 2007, every PA who electronically submits claims or transfers health care information must use a National Provider Identifier (NPI) number. This requirement applies to all electronic Medicare transactions as well as claims activity for private payers.
It takes about 20 minutes for health care professionals to apply for the NPI number on line at https://nppes.cms.hhs.gov. You will need state licensure information in order to complete the application. In addition, it is advised that you provide any existing identification numbers (e.g., Medicare provider identification number or provider numbers of private payers), known as legacy numbers, in your NPI application. This will allow payers to crosswalk your legacy numbers to the NPI number. A paper application may be obtained from Fox Systems, the company overseeing NPI enrollment, by calling 800/465-3203.
The ten-digit NPI number will be the only identifying number used to recognize health care professionals by all payers including Medicare, Medicaid, worker’s compensation programs, and the host of private payers such as Blue Cross/ Blue Shield, United Health care, CIGNA, and Aetna. The NPI number will stay with the health care professional for life and will not change by work setting or employer.
CMS estimates that there are approximately 2.3 million PAs, physicians, hospitals, and other health care professionals/entities that must obtain an NPI to date. Waiting until the last minute may cause NPI application systems to slow and result in delayed claims processing and payments. For those PAs who work for larger employers, check with your business office to make sure that the organization hasn’t already applied for an NPI number on your behalf as part of a bulk application process.
CMS – 1500 FORM
The CMS – 1500 form is the official billing form used to submit claims to Medicare and the myriad of other public and private payers. In 2006, under the auspices of the National Uniform Claims Committee (NUCC), the 1500 form was revised to allow for the incorporation of the NPI number and for other more minor changes. A PA serves on the NUCC.
Specific changes to the 1500 form can be found in fields 17a, 214, 32 and 33, all of which have been modified to allow for insertion of the NPI number. Box 17 was changed from “name of referring physician or other source” to “name of referring provider or other source” to reflect the growing presence of non-MD/DO health care professionals. Most of the other changes were cosmetic in nature.
Implementation of the new 1500 form is as follows:
January 2-March 30, 2007, health care professionals and offices may use the current 1500 form (dates 12-90) or the revised form (dated 8/05).
On and after 2, 2007, only the revised form can be used.
Most electronic billing software systems will require a minor modification to update the various fields on the 1500 form. Contact your software vendor for more details. As with obtaining an NPI number, avoid waiting until the last minute to pilot test your system so as to avoid delays in claims processing and payment.