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Project Management Baseline for TPOCS NPI Requirements

Project Management Baseline for TPOCS NPI Requirements. UBO Functional Support Revised CMS 1500/UB-04 UBO Support Contract Staff Medical Management SME November 2006. UBO Functional Support - NPI Agenda. Current Status Baseline Requirements Overall Assessment Project Summary

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Project Management Baseline for TPOCS NPI Requirements

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  1. Project Management Baseline for TPOCS NPI Requirements UBO Functional Support Revised CMS 1500/UB-04 UBO Support Contract Staff Medical Management SME November 2006

  2. UBO Functional Support - NPIAgenda • Current Status • Baseline Requirements • Overall Assessment • Project Summary • Confirm Decisions/Recommendations/Action Items

  3. UBO Functional Support - NPICurrent Status • TPOCS Requirements completed: • Revised CMS 1500 • UB-04 screen and form requirements for NPI • TPOCS Requirements pending: • UCF • Prescriber ID and Qualifier • UB-04 • Rx billing form requirements • Mapping for new data fields • Screen requirements • Open TPOCS fields • Patients and Policies screen • Pharmacy Billing screen • Reports

  4. UBO Functional Support - NPIBaseline Requirements • UBO functional guidance and requirements will be provided to TPOCS for the revised CMS 1500/UB-04 format and UCF form. • UBO functional guidance and requirements will be provided to TPOCS for screen and system design. • *All requirements must be delivered to TPOCS no later than 1 November 2006, for testing. *Deadline extended to 16 November 2006

  5. UBO Functional Support - NPIOverall Assessment (CMS 1500 - 18 August 2006)

  6. UBO Functional Support – NPIOverall AssessmentRx Billing Form Requirements – UCF/UB-04

  7. UBO Functional Support - NPIOverall Assessment UB-04 – 14 November 2006

  8. UBO Functional Support - NPIProject Summary – 14 November 2006 Significant Events • NPI implementation • There will only be one NPI Type 2 per facility • NPI field added on TPOCS Billing Screen as an open field • Taxonomy code will be used as an additional Identifier • NPI Type 2 of Treatmnt/Dispensing MTF will be used for all Rx claims

  9. UBO Functional Support - NPIProject Summary – 14 November 2006 • TPOCS System Changes • Lab/Rad • Split bill to be created • Certifying/Verifying Provider will be a required field in CHCS • Pharmacy NCPDP Compound Code Indicator • Reject data flow in field 22 from CHCS to TPOCS • SIT Screen • Contact Carrier field will be opened to billers • Policies Screen • Number of fields will be opened to billers • BIN# and PCN# fields added to replace Drug Coverage# field • E-bills • Status for rejected e-bills changed from “ready to print” to “incomplete”

  10. UBO Functional Support - NPIProject Summary – 14 November 2006 • Revised CMS 1500 Format • ER visits will be identified with MEPRS code BIA* • Place of Service code will be “23” and EMG indicator default to “Y.” • Custom CMS 1500 Screen redesigned

  11. UBO Functional Support - NPIProject Summary – 14 November 2006 Significant Events • UCF • NPI Type 2 of the Treatment/Dispensing MTF for all Rx claims • Field 5-Service Provider ID -NPI Type 2 of Dispensing Facility • Field 15- Provider ID- NPI Type I of dispensing provider

  12. UBO Functional Support - NPIProject Summary – 14 November 2006 • TPOCS System Changes • Pharmacy • Pharmacy/Bill Type-2 will include • NPI Type 2 for the facility • DEA# for the dispensing provider- Pending • NPI Type I for dispensing provider • Site Maintenance Screen • Allow user to enter NCPDP (NABP#) data • Site Insurance Screen • Move NABP# data field from Site Maintenance Screen to Site Insurance Screen

  13. UBO Functional Support - NPIProject Summary – 14 November 2006 • UB-04 • FL 56 – National Provider ID- NPI Type 2 of the facility • FL57- Other Billing Provider ID- Attending/Rendering Legacy ID will populate in this field • FL76- Attending Physician Name and Identifiers- NPI Type I of Provider if reported or NPI Type II of the Facility

  14. UBO Functional Support - NPIOpen Action Items- 14 November 2006

  15. UBO Functional Support - NPIOpen Action Items - 14 November 2006

  16. UBO Functional Support - NPIProject Summary • Projected Events • TPOCS IOT testing kickoff – 11 December 2006 • Complete UCF/UB-04 form and screen requirements for TPOCS – 14 November 2006 • Conduct Audioteleconference for CMS 1500/UB-04 – January 2007

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