News and Updates

Medicare Proceeding Towards NPI-only on May 23

(May 14, 2008)

But some Medicaid and other plans not ready

Today the Centers for Medicare & Medicaid Services (CMS) conducted a national telephone call on the National Provider Identifier (NPI). Its announcements included the following:

The Medicare program is still on target towards requiring NPI-only identifiers for identification of all providers found on claims and other related HIPAA transactions, starting May 23.
The recent Medicare "legacy-free" day showed positive results. CMS had been concerned that the numbers of NPI-only claims being submitted have been low. However, on this day they had gotten a number of clearinghouses to send NPI-only, whereas apparently the clearinghouses have otherwise been sending both. The percentage of NPI-only claims received by Medicare on that day was 70-80% and most processed successfully.
Most Medicaid and commercial health plans secondary to Medicare tell CMS that they will be ready to handle NPI-only cross over claims. However, a few Medicaid and commercial plans say they will not be ready. These plans should be notifying providers to instruct on how to submit the secondary-to-Medicare claims.
As with past aspects of Healthcare Insurance Portability and Accountability Act (HIPAA) enforcement, CMS will operate through its complaint-driven process regarding potential violation of the HIPAA NPI regulation.

According to one caller, of over 900 payers to which her provider submits claims, less than 150 of them have documented they are ready for NPI-only. CMS said a way to address this is to file complaints with the agency. Earlier on the call, CMS said of about 500 HIPAA transaction complaints handled by the agency, no complainer had experienced any “retribution” against them.

Another caller said that quite a few payers have announced they will still require legacy identifiers after May 23. To this, a CMS spokeswoman repeated advice that complaints can be filed while a spokesman softened that message in stating CMS encourages providers to work with health plans and clearinghouses to understand their perspectives to resolve such issues.

NHIA provides a comprehensive resource for NHIA members in its HIPAA NPI Resource Center.