Department of Health & Human Services

Tips for Health Care Professionals – Preparing Your Office Staff for NPI

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EVERY provider completing electronic transactions MUST use only the NPI to identify covered healthcare providers in standard transactions by May 23, 2007.  This means you MUST apply for and receive an NPI to use on HIPAA claims transactions before May 23, 2007.  (See Important web links below).

 

Health care professionals who are health care providers need to prepare themselves, and their staff, for the upcoming NPI compliance date.  Careful preparation for, and use of, the NPI will help minimize claim errors and delays in payment.

Getting Started

 

As health care professionals, you need to:

• Get your NPI.
• Familiarize yourself with information available from CMS, private industry groups (e.g., WEDI) and your business partners.
• Determine if there are any State laws or requirements that impact obtaining an NPI.
• Communicate with the health plans with which you do business and determine their NPI implementation timelines.
• Identify your vendors, trading partners and business associates – contact them and determine their readiness to deal with NPI.
• Ensure that any health plan, clearinghouse or other vendor that you use is accepting the NPI before you use it in your transactions.
• Get your NPI soon and share it with trading partners and other colleagues who need it to bill for services or your cash flow may be disrupted after the compliance date. 

 

Implementing the NPI in Your Business – Training Staff

Once you’ve done your research and obtained your NPI, then you must begin implementation.  Staff training is important; all staff should have an understanding of the NPI and anticipate the changed in business practices due to the implementation of NPI.  Certain staff members will need to know the requirements of its use and where it appears in transactions.

 

Training should include:

• Any new responsibilities or business processes that come about as a result of the NPI, such as; how and when to disseminate a provider’s NPI, how to protect is, and when to collect it from other providers for use in HIPAA standard transactions. 
• Staff will need to know what to do if another provider’s NPI is needed in a HIPAA standard transaction and is unknown (e.g., ordered or referred services).
• Developing a plan for who will be responsible for ensuring that the NPIs are kept up to date.
• Plan and execute your staff on how NPIs from other organizations or peers will be collected and validated for use in HIPAA standard referral transactions.
• Create a process for sharing your NPI with your business partners for billing purposes.

 

Impact on Business Processes

In addition to impacting the HIPAA standard transactions, the implementation of the NPI could impact several additional business processes and systems that health care professionals rely on every day.  Stay ahead of the curve and begin proactively reviewing these processes to see if NPIs should be used in them and, if so, plan for NPI implementation. 

Business processes that should be reviewed include:

• Business computer systems and software, such as the Practice Management System, to identify all places that a provider identifier is used.
• Do you have Electronic Medical records?
• Do you participate in ePrescribing? Do you use a CPOE (computerized physician order entry) system?
• Internal staff who work with these systems must understand the impact of using the NPI in place of all other provider identifiers.
• Any document imaging or archival system that you may use to determine if it needs updating to accommodate the NPI.
• Workflow processes – to see if a provider identifier is used for routing or indexing.  Both internal and external reports could be affected.
• All HIPAA standard transactions are impacted by the NPI – not just electronic claims.  For example, make sure that you review the needs of the payment and remittance advice, claims status inquiry and response, and eligibility inquiry and response.

Finally, stay on top of the timelines for NPI implementation that are established by your trading partners.  As the compliance date of May 23, 2007 nears, some health plans may request that all transactions submitted as of a certain date contain both the old legacy identifier and the NPI.

Stay connected with up-to-the-minute-information available from:

CMS

www.cms.hhs.gov/NationalProvIdentStand

and

WEDI

www.wedi.org/npioi/

 

This tip sheet was provided by CMS as a service to the public and is not intended to grant rights or impose obligations.  This tip sheet may contain references or links to statutes, regulations, or other policy materials.  The information provided is only intended to be a general summary.  It is not intended to take the place of either the written law or regulations.  We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.