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Medisoft Version 11 and National
Provider ID (NPI) Mandate |
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The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
mandated that the Secretary of Health and Human Services adopt a standard
unique health identifier for health care providers. On January 23, 2004, the
Secretary published a Final Rule adopting the National Provider Identifier (NPI)
for this requirement. All HIPAA covered healthcare providers, whether they
are individuals or organizations, must obtain an NPI to identify themselves
in HIPAA standard transactions. Once established, a provider's NPI will not
change. The NPI remains with the provider regardless of job or location
changes.
Effective May 23, 2007,
the Centers for Medicare & Medicaid Services (CMS) claims processing systems
will only accept claims that include NPI numbers. At the same time, all
providers completing electronic transactions, healthcare clearinghouses, and
large health plans, must use the NPI to identify covered healthcare
providers in standard transactions.
To ensure that
you can continue to send electronic claims after the May 2007 deadline, be
sure that your Medisoft program has been updated to Version 11. The
link to apply for your NPI number is
http://nppes.cms.hhs.gov/NPPES/Welcome.do.
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NPI Timeline Schedule
Medicare's implementation involving acceptance and processing of
transactions with the NPI will occur as follows:
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May 23, 2005 - Jan
2, 2006: |
Providers should
submit Medicare claims using only their existing Medicare numbers.
They should not use their NPI numbers during this time period. CMS
claims processing systems will reject and not process any claim that
includes an NPI during this phase. |
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Jan 3, 2006 - Oct 1,
2006: |
Medicare systems
will accept claims with an NPI, but an existing legacy Medicare number
must also be on the claim. Note that CMS claims processing systems
will reject and not process any claim that includes an NPI only.
Medicare will be
capable of sending the NPI as primary provider identifier and legacy
identifier as a secondary identifier in outbound claims, claim status
response, and eligibility benefit response electronic transactions. |
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Oct 2, 2006 - May
22, 2007: |
CMS systems 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.
Therefore, Medicare
strongly recommends that providers, clearinghouses, and billing
services continue to submit the Medicare legacy identifier as a
secondary identifier.
Medicare will be
capable of sending the NPI as primary provider identifier and legacy
identifier as a secondary identifier in outbound claim, claim status
response, remittance advice (electronic but not paper), and
eligibility response electronic transactions. |
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May 23, 2007 -
Forward: |
CMS systems will
only accept NPI numbers from all providers completing electronic
transactions, healthcare clearinghouses, and large health plans. Small
health plans have an additional year to be NPI compliant. |
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What does this mean for Medisoft users?
Medisoft Version 14 is READY
for the May 23, 2007 deadline to submit claims electronically and
in to generate CMS 1500 printed claims. Although Medisoft Versions 9 and 10
include a field that can store an NPI, these versions, along with prior
Medisoft versions, do not include software that enables electronic claims
submission with the required NPI nor will they be able to produce paper
claims using the new required form. |
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What
about Direct Modules?
McKesson Corporation,
will continue to support the published list of Direct Modules for Medisoft
Version 11.
What about our Clearinghouse?
Both
the Stratus and the Phoenix platforms will support the mandated NPI
changes. Please keep in mind that the Phoenix platform supports many
additional payers, more remittance connections and Electronic Eligibility
Verification services.
To view additional details
about our clearinghouse's NPI Strategy, please click on the following link
to get additional details
http://www.medavanthealth.com/npi.aspx.
Additional information and bulletins can be found at the Centers for
Medicare and Medicaid Services website at
http://www.cms.hhs.gov/default.asp?.
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