Transcript National Provider Identifier

National Provider
Identifier
Western Highlands Network
National Provider Identifier
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What is NPI
Why do we need the NPI
Who can apply
How to obtain an NPI
How to register with WHN
How to bill WHN
Sources
What is NPI
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The Health Insurance Portability and
Accountability Act (HIPAA) of 1996
requires the adoption of a standard
unique identifier for health care providers
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The NPI is a 10-digit unique identifier
issued by the National Plan and Provider
Enumeration System (NPPES)
Why do we need the NPI
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The NPI will replace health care
providers identifiers in HIPAA standard
transactions. This includes Medicare,
Medicaid, and LME legacy identifiers.
• It doesn’t ensure licensure or credentials;
guarantee payment, enroll a provider, or
require a provider to conduct HIPAA
transactions.
Who can apply
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All health care providers.
• A health care provider can be an individual or
organization that renders health care as
defined by 45 CFR 160.103.
How to obtain an NPI
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Apply for an NPI through the National
Plan and Provider Enumeration System
(NPPES)
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https://nppes.cms.hhs.gov/NPPES/Welcome.do
How to register with WHN
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Two Methods
• Send a copy of your Medicaid registration with
NPPES certificate
Or
• Send the WHN NPI Registration Form and
NPPES certificate
How to register with WHN (cont)
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Legacy provider identifier
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NPI
Taxonomy
Physical address Zip +4
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Used for mapping solutions
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• Medicaid or LME Provider Number
How to bill WHN
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CMS 1500 (08/05)
837
Direct Data Entry
Explanation of Benefits
CMS 1500 (08/05)
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Instructions published in NC Medicaid
Special Bulletin, December 2006,
New Claim Form Instructions
 Effective Jan 1, 2007
 Must submit claims on CMS1500
(08/05) by April 1, 2007
 NPI Implementation May 18, 2007
837
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WHN will follow Medicaid 837
requirements
A WHN 837 Companion Guide is
available
• Replace legacy provider identifiers with NPI
• Adding Taxonomy
• Adding Zip+4
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NLT May 18, 2007
Direct Data Entry
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Under development
• NPI
• Taxonomy
• Zip+4
Explanation of Benefits
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Under Development
Information Sources
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CMS
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http://www.cms.hhs.gov/
NC Division of Medical Assistance
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http://www.dhhs.state.nc.us/dma/NPI.htm
NPPES
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https://nppes.cms.hhs.gov/NPPES/Welcome.do
WHN
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http://www.westernhighlands.org/forproviders.htm
[email protected]
(828) 225-2800 ext. 2191
WEDI
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http://www.wedi.org/