National Provider Identifier (NPI)

Attention Providers:  Additional information on National Provider Identifiers on Crossover Claims

June 16, 2008

The Centers for Medicare & Medicaid Services (CMS) has been alerted that small numbers of Coordination of Benefits Agreement (COBA) trading partners are having difficulty accepting 837 professional crossover claims where the 2310A loop ("Referring Physician” NM108 and NM109 segments are blank and also missing the accompanying "REF" segment. Providers would have transmitted these professional claims to Medicare prior to May 23, 2008, without an NPI. The Coordination of Benefits Contractor (COBC) has no method for re-sending these already transmitted claims with the 2310-A REF segment included. Therefore, if Kentucky Medicaid experience problems with accepting 837 professional claims due to translator programming, we will inform providers that it will be necessary for them to bill Kentucky Medicaid directly for these claims.

To mitigate further occurrences of the 2310-A REF problem within your 837 professional claim files, the COBC will, effective with June 11, 2008, no longer transmit claims that do not contain an NPI value where required.

If you have further questions, contact the EDI Helpdesk at (800) 205-4696.

Still have questions? Need more Information? If so, click the links below for more information on:

• What is the NPI
• Getting your NPI
• Sharing your NPI
• Using your NPI

What is the National Provider Identifier (NPI)?

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard.  The NPI is a unique identification number for covered health care providers.  Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA.  The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.

Getting your NPI

Providers who have not yet applied to FOX Systems for their NPI should do so as soon as possible.

Note: Providers who do not already have a taxonomy, may refer to the Washington Publishing Company to choose a taxonomy(s).

Health care providers can apply for NPIs in one of three ways:

• For the most efficient application processing and the fastest receipt of NPIs, use the web-based application process.  Simply log onto the National Plan and Provider Enumeration System (NPPES) and apply on line.
• Health care providers can agree to have an Electronic File Interchange (EFI) organization (EFIO) submit application data on their behalf (i.e. through a bulk enumeration process) if an EFIO requests their permission to do so.
• Health care providers may wish to download a copy of the paper NPI Application/Update Form (CMS-10114) and mail the completed, signed application to:
  
  NPI Enumerator
  P.O. Box 6059
  Fargo, ND 58108-6059

Sharing your NPI

Once providers obtain their NPI and taxonomy code(s), FOX Systems will issue verification. To submit your NPI and taxonomy code(s) to KyHealth Choices, print and complete this form and include with your FOX Systems verification. Mail or fax these documents to:

First Health
NPI/Taxonomy
P.O. Box 2110
Frankfort, KY 40602
Fax: (502) 607-8401

Providers, if you have additional questions about filing and sharing your NPI with Kentucky Medicaid, please see the list of Frequently Asked Questions about registration.

Using your NPI

Providers who have registered their NPI and taxonomy(s) with Kentucky Medicaid should start billing both the correct NPI and taxonomy, on the claim effective for any dates of service on or after the day they were notified by Kentucky Medicaid that their NPI and taxonomy(s) were registered.

In addition, providers who have one NPI and multiple provider ID's should note that Kentucky Medicaid "strongly encourages and suggests" in order to uniquely identify the provider when processing claims, that the provider bill the appropriate taxonomy with the NPI.

For more information on how to bill with an NPI, click to view the Frequently Asked Questions regarding filing a claim with the NPI or refer to the Provider Billing Instructions. In addition, providers can reference the KY Companion guides for the appropriate 837 transactions they are billing.