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Calls for Extension of NPI Contingency Period Past May 23

(April 21, 2008)

Two industry groups designated as "Data Management Standards Organizations (DSMOs)" under HIPAA regulation have requested an extension of the Healthcare Insurance Portability and Accountability Act (HIPAA) National Provider Identifier (NPI) contingency period.  Scheduled to end on May 23, 2008, the groups have asked for an extension of six months.

In an April 17 letter, the National Uniform Claims Committee (NUCC) writes that “testing of claims with NPI only has shown significant issues with some payers’ ability to map NPI to legacy numbers and appropriately process and adjudicate claims.”  It adds that Medicare recently reported only about 15% of claims are received with NPI only, and that it is uncertain how many processed without difficulties.  The group also writes that there have been anecdotal reports of Medicare not being able to process claims with NPI only, resulting in payment delays and need for further work by the provider.  The NUCC is the “data content” organization for the medical billing claim form (CMS-1500) and its electronic equivalent claim transaction standard used by home infusion providers and others.

In a letter released April 16, the National Uniform Billing Committee (NUBC) also requested a six-month extension.  The NUBC is the “data content” organization for the institutional claim form (UB-04) and its electronic equivalent claim transaction standard used by hospitals and others.  This group pointed out that CMS has recently changed direction in guidance given to hospitals’ use of NPI subparts that will be very disruptive.  It writes that the transition to NPI has become a “painful experience” for many provider organizations due to “substantial follow-up to correct or add information to the NPI database.”

Both DSMO groups are balanced in their membership between providers and payers.  The Centers for Medicare & Medicaid Services (CMS), which administrators Medicare and many aspects of the transition to HIPAA electronic standards, is a member of both groups.