May 23 is the NPI compliance deadline
With the May 23 enforcement deadline for national provider identifier implementation fast approaching, dentists must remember to contact their system vendors and clearinghouses to ensure their readiness and test with them before sending NPIs on their electronic claim forms.
The ADA is receiving complaints from some dentists who bypassed these steps and then had claims held up, their reimbursements put on hold.
To be ready, dentists have to first obtain an NPI, then successfully test it with their business partners who will need the NPIs to pay benefits.
The purpose of the NPI is to identify providers and provider facilities independently of their taxpayer information. It’s a 10-digit standard identification number required under the Health Insurance Portability and Accountability Act that will replace legacy numbers such as license numbers, Social Security numbers and dental-plan specific identifiers plans use to identify providers.
“I would like to remind all dentists who have not filed for their NPI number that the implementation date is May 23,” said Dr. Robert Shaw, chair of the Council on Dental Practice. “Dentists should apply for their number well before that date and be prepared to use it by that date. Dentists should remember to check with their payers and clearinghouses to see if they can accept claims with their NPI before using it, and they should also check with their practice management vendors to verify that their systems can incorporate the NPI number.”
Jean Narcisi, director of the ADA Department of Dental Informatics, says, “The provider identifier is at the heart of the billing and claims payment process for every covered entity. Successful implementation of the NPI and its use in internal systems and external transactions will be important for continued reimbursement.”
The Workgroup for Electronic Data Interchange completed its sixth NPI readiness assessment survey and the results demonstrate a strong movement towards industry compliance. However, much work still remains. Comprehensive trading partner testing is critical. The survey data indicates that the industry is showing improvement in this area but time is growing short.
“The goal of NPI compliance across the industry by May 23 will be a challenge,” according to the workgroup. The report says the likelihood that isolated system breakdowns may occur should be anticipated, particularly if one exchanges data with a large number of trading partners. Procedures to address system breakdown events should be comprehensive and communicated early.”
The Centers for Medicare & Medicaid Services pushed back the original enforcement date by one year because many covered entities would not be able to fully comply with the standard by May 23, 2007. Plans were off the hook for 12 months if they had been making a good faith effort to comply with the NPI provisions, but dentists weren’t if the plan decided to end its contingency plan voluntarily in advance of the deadline. In addition, the contingency period applied only to HIPAA transactions, meaning dental plans would have the prerogative to require the NPI on paper claims before the 12 months was up. Some payers were already doing this last year.
NPI information at a glance
Visit https://nppes.cms.hhs.gov to submit an application for a national provider identifier or to look up NPIs on the NPI registry.
Dentists who use electronic transactions must be able to include NPIs on their electronic transactions by May 23, 2008. Contact your system vendor and/or clearinghouse in order to ensure readiness for the deadline.
The NPI is not a substitute for taxpayer identification, such as a Social Security number, individual taxpayer identification number or employer identification number. That means dentists have to include at least one NPI, one tax ID and one license number on all electronic claims after May 23.
Paper-based offices may be required by some dental plans to include NPIs on paper claims, even though this is not required by federal law.
The 2006 ADA claim form is the only version of the ADA paper claim forms designed to support the use of NPIs.聽 Instructions are published in chapter four of “CDT 2007-2008.” The ADA urges those filing paper claims to read these instructions before submitting claims using the 2006 ADA form. To obtain a copy of CDT 2007-2008, call the ADA catalog at 1-800-947-4746 or visit www.adacatalog.org.聽