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National Provider Identifiers (NPI)
at Mercy Health Plans (MHP)
MHP's NPI Contingency Plan
On April 2, 2007, the Department of Health
and Human Services (DHHS) issued guidance for covered entities regarding
contingency planning for NPI implementation.
“As long as covered entities, including
health plans and covered health providers, continue to act in good faith
to come into compliance, meaning they are working towards being able to
accept and send NPIs, they may establish contingency plans to facilitate
the compliance of their trading partners.” (You can find this guidance
on the
CMS website).
MHP’s
NPI Implementation Contingency Plan includes the following important dates:
- Beginning 08/01/07, MHP will require use of CMS 1500 (08/05) and UB-04 forms
HIPAA regulations require the use of NPIs on electronic transactions; however, MHP encourages
providers to submit claims electronically and will require use of NPIs on
all paper claims. The updated forms will allow use of NPIs. Older versions
of the forms are subject to rejection beginning August 1, 2007.
- Until 01/01/08, MHP will accept dual provider numbers (NPI and legacy numbers).
Providers are encouraged to transmit claims with both their NPI and legacy provider identifiers (Medicare, UPIN,
or MHP Provider ID) until January 1, 2008.
When entering your legacy identifier, remember to add the appropriate 2-digit qualifier in front of your number.
EX: 1C for Medicare, 1G for UPIN, or G2 for MHP Provider ID number.
Also, please ensure that your Tax ID accompanies the NPI on all claim submissions (per X12/837 guidelines).
- Beginning 01/01/08, claims without NPIs will be subject to rejection.
MHP recognizes that providers need additional time to share their NPIs with covered healthcare providers,
clearinghouses and health care plans, as well as testing of electronic transactions between covered entities.
Our goal is to support those needs, avoid interruption of payment to our providers and ensure a smooth
transition to use of the new identifier system.
Sharing your NPI with MHP
- Before using your NPI(s) for claim submission, MHP must update your provider file with NPI information.
- Share your NPI information with MHP by either of the following methods:
- Access our NPI Submission form online at mercyhealthplans.com/provider
- Mail your NPI information to:
Mercy Health Plans, PIM Department
14528 S. Outer 40 Rd, Suite 300
Chesterfield, MO 63017.
- For assistance with any NPI issues or to submit bulk loads, including facilities with multiple subparts, you may either:
How the CMS “Guidance on Compliance with the HIPAA National Provider Identifier
(NPI) Rule” Affects Providers.
- The guidance issued on April 2, 2007 by CMS does not give providers an extra year to obtain an NPI.
- The deadline for obtaining your NPI(s) was May 23, 2007.
- The guidance allows healthcare plans, providers, and clearinghouses additional time to make necessary
changes to systems and to communicate NPI information within the business environment.
- A good faith effort must be made to become compliant.
- Until May 23, 2008, CMS will not impose penalties on any covered entity, as long as they are making, and
can prove they are making, “reasonable and diligent” efforts to become compliant.
- CMS suggests documenting efforts to become compliant. If CMS receives complaints regarding your efforts
to become compliant, an investigation and review of your contingency plan will be performed.
- By May 23, 2008, all covered entities will be required to be NPI compliant.
- There will be no extension past this date.
To ensure compliancy as a provider, you need to do the following:
- Have your NPI(s)!
- If you have not already applied for your NPI, do so right away.
- Update your systems.
- Be sure that software vendors have completed programming and test systems so NPI(s) can be used to submit HIPAA
transactions.
- Check the readiness of healthplans and clearinghouses.
- Review our contingency plan and the plans of others with whom you do business,
to know when and how to use your NPI(s) to submit transactions.
- Document your efforts to become compliant.
For additional information about NPIs, or to apply for an NPI, visit the
CMS website.
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