There are too many numbering schemes in the U.S. to identify healthcare providers. Most physicians today have a Social Security Number, Employer Identification Number, Drug Enforcement Administration number, State License Number, Medicare Provider Number, Medicaid Provider Number, Blue Cross Provider Number, CHAMPUS Provider Number, State Industrial Accident Provider Number, and on, and on, and on. Keeping track of all of these numbers causes major problems in healthcare reimbursement. But that’s about to change.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique identifier for health care providers. It took nearly 10 years, but the National Provider Identifier (NPI) has finally arrived and the industry is fast preparing for the May 23, 2007 mandatory compliance date.
The NPI numbers are assigned by the Centers for Medicare and Medicaid Services. The NPI is a numeric 10-digit identifier, consisting of 9 numbers plus a check-digit in the 10th position. Healthcare providers can get more information at the National Provider Identifier web site or apply online at the National Plan and Provider Enumeration System web site. Medicare recommends that you apply for an NPI immediately, but no later than November 2006.
There are certain timelines you need to know:
Jan 3, 2006 – Oct 1, 2006 – Medicare will accept claims with an NPI, but an existing legacy Medicare number must also be on the claim. Medicare will reject, as unprocessable, any claim that includes only an NPI.
Oct 2, 2006 – May 22, 2007 – Medicare will accept an existing legacy Medicare billing number and/or an NPI on claims. If there is any issue with the provider’s NPI and no Medicare legacy identifier is submitted, the provider may not be paid for the claim.
May 23, 2007 – Forward – Medicare will only accept NPI numbers. Small health plans have an additional year to be NPI compliant.
Kareo is doing its part to comply with the NPI standards. You can already setup an NPI as a provider number for a provider in your practice settings. The NPI will be sent along with electronic claims today. Also, Kareo will be supporting a new version of the CMS 1500 form designed to support NPI numbers by October 1, 2006. If you have any questions about Kareo’s support for NPI, you can email support@kareo.com.
