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Update on National Provider Identifier (NPI)

Update on National Provider Identifier (NPI). Stephanie Anderson, CPC Coordinator of Network Compliance Programs October 2006. Overview. National Provider Identifier (NPI) Applications Accepted: May 23, 2005 Compliance Date to Use ONLY the NPI: May 23, 2007

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Update on National Provider Identifier (NPI)

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  1. Update on National Provider Identifier (NPI) Stephanie Anderson, CPC Coordinator of Network Compliance Programs October 2006

  2. Overview • National Provider Identifier (NPI) • Applications Accepted: May 23, 2005 • Compliance Date to Use ONLY the NPI: May 23, 2007 {Small Health Plans = May 23, 2008} Community Care Network of Virginia, Inc.

  3. Overview • National Provider Identifier (NPI) • After implementation ~ only the NPI will identify providers in ALL standard transactions • Each FQHC will have an organization NPI • ENTITY TYPE 1 • Individual Providers will have an individual NPI • ENTITY TYPE 2 • UPINs, Medicaid #s, Private Insurer #s, etc. WILL NOT be permitted after May 23, 2007 • 10-digit identifier - “intelligence-free identifier” Community Care Network of Virginia, Inc.

  4. Overview • National Provider Identifier (NPI) • Does not expire (certain exceptions apply) • Once the # is assigned, providers must furnish updates to the data within 30 days of any changes • CCNV has the information to update these applications IF we applied for the NPI. • Provider’s should have a copy of their official NPI notification or know how to get it. Community Care Network of Virginia, Inc.

  5. CCNV NPI ProcessTo Date: • Began applying for Network Providers’ NPIs in November 2005 • Applications are made for Organization & Individual Providers • Use Credentialing Database for current providers • Credentialing Department applies for the NPI once they receive a CCNV Credentialing Application • Center Contacts are sent NPI notifications via e-mail or US mail Community Care Network of Virginia, Inc.

  6. CCNV NPI ProcessTo Date: • CCNV applies for NPIs for: • Organization (Entity Type 1) • Medical Center • Pharmacy • Individual Provider (Entity Type 2) • (MD, DO, PA, NP, LCSW, Dentist, Pharmacist, etc.) • Center site must be his/her primary location Community Care Network of Virginia, Inc.

  7. CCNV NPI ProcessTo Date: • Current Network Providers should have: • An assigned NPI from the NPPES (official notification) on file at CCNV and Center OR • An application in process, if provider is new to the CCNV Network OR • An NPI official notification sent to us from a previous employer Community Care Network of Virginia, Inc.

  8. NPI Application Tidbits • Contact Person listed on Application • Must be updated when provider changes practice locations • NPPES will only give information to contact person or provider • E-mails will only be sent to contact person’s listed e-mail • Log-on/password details • Very important to update provider information Community Care Network of Virginia, Inc.

  9. NPI Application Tidbits • What are Taxonomy Codes? • Numbers assigned under the HIPAA provisions to health care providers, • Encoding process that recognizes specialty • Facilitates electronic billing • Every NPI application must have a taxonomy code (ex. FQHC = 261QF0400X • http://www.wpc-edi.com/codes/taxonomy Community Care Network of Virginia, Inc.

  10. NPI Implementation TimelineElectronic Claims Community Care Network of Virginia, Inc.

  11. CMS NPI Education Resource • http://www.cms.hhs.gov/NationalProvIdentStand/04_education.asp#TopOfPage Community Care Network of Virginia, Inc.

  12. Additional Resources Available • NPI Final Rule - January 2004 http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2004/pdf/04-1149.pdf • CMS NPI Resource Center • http://www.cms.hhs.gov/apps/npi/01_overview.asp Community Care Network of Virginia, Inc.

  13. Questions?? Community Care Network of Virginia, Inc.

  14. Thank You ! Stephanie Anderson, CPC Community Care Network of Virginia, Inc. 6802 Paragon Place Suite 630 Richmond, VA 23230 (T) (804) 237-7686 x 102 E-Mail: sanders@ccnva.com Community Care Network of Virginia, Inc.

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