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The NPI effective date is here. By now, health care providers are well aware of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandate that the Secretary of Health and Human Services (HHS) adopt a standard unique health identifier for health care providers. HHS created the National Provider Identifier (NPI) for use on all electronic transactions, such as claims submissions, referral requests and others. According to original plans, the NPI was to be the sole provider identifier as of May 23, 2007, replacing the multiple provider identification numbers that have been used in the past. The use of Medicare Unique Physician Identification Numbers (UPINs), proprietary payer IDs, TRICARE numbers, Medicaid IDs, etc. were to be no longer accepted on electronic transactions as of that date. However, on April 2 of this year, CMS announced a change in compliance enforcement. Although the effective date remains May 23, 2007, CMS has extended the enforcement not to exceed May 23, 2008, provided a covered entity demonstrates good faith toward compliance.
The NPI will not replace provider certification identifiers, DEA numbers or tax IDs. Specialty providers that are contracted with more than one specialty should also submit their taxonomy code to determine which specialty they are billing for, especially if they are using the same NPI for both. All HIPAA-covered health care providers, whether individuals or organizations, must send their NPI on all HIPAA electronic transactions. NPI must be the primary identifier in each of the following HIPAA-mandated electronic transactions:
Health care providers will need to supply their NPI to other third parties for transactions, such as referrals and prescriptions. Providers sending paper claims are encouraged to use the CMS 1500 professional claim form, the updated American Dental Association (ADA) form and the updated UB04 institutional claim form for paper claims submission. These new and updated forms all feature NPI fields. Health care providers need to follow their individual state mandate, which may require using NPI on paper claims. How do I notify Humana of my NPI number?
What if I haven't applied for my NPI yet?
To have an application form mailed or for more information about the NPI application process, contact the NPI Enumerator directly at (800) 465-3203, or visit http://www.cms.hhs.gov/NationalProvIdentStand/ Para obtener más información sobre el uso de Humana de los NPI, visite www.humana.com and click on "Providers" and then "NPI" under "Quick Links". For additional information, call 1-800-4-HUMANA.
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Humana's plans are to enforce claim compliance beginning October 1, 2007. In the coming months, between May and October, Humana will regularly monitor provider readiness before enforcement is imposed. Currently, Humana is able to accept HIPAA-compliant transactions and will continue to support claims with an NPI only, as well as claims with dual identifiers that use a Humana-specific ID.
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