What is NPI? NPI is the acronym for the National Provider Identifier ...
What is NPI? NPI is the acronym for the National Provider Identifier ...
What is NPI? NPI is the acronym for the National Provider Identifier ...
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<strong>What</strong> <strong>is</strong> <strong>NPI</strong>?<strong>NPI</strong> <strong>is</strong> <strong>the</strong> <strong>acronym</strong> <strong>for</strong> <strong>the</strong> <strong>National</strong> <strong>Provider</strong> <strong>Identifier</strong> (<strong>NPI</strong>). It <strong>is</strong> one prov<strong>is</strong>ion of <strong>the</strong> Admin<strong>is</strong>trativeSimplification portion of <strong>the</strong> Health Insurance Portability and Accountability Act of 1996 (HIPAA).<strong>What</strong> <strong>is</strong> <strong>the</strong> purpose of <strong>NPI</strong>?The <strong>NPI</strong> <strong>is</strong> a single identification number that will be assigned by <strong>the</strong> federal government to health careproviders. The <strong>NPI</strong> will be used to identify physicians, hospitals and o<strong>the</strong>r medical professionals in allelectronic HIPAA transactions. It <strong>is</strong> intended to improve <strong>the</strong> efficiency of <strong>the</strong> health care system and help toreduce fraud and abuse.Get Your <strong>NPI</strong> NowCountdown has begun; do you have your <strong>NPI</strong>? Don't r<strong>is</strong>k d<strong>is</strong>ruption to your cash flow. Get your <strong>National</strong><strong>Provider</strong> <strong>Identifier</strong> (<strong>NPI</strong>) now! The <strong>NPI</strong> must be used in all HIPAA transactions by all coveredentities⎯health plans, health care clearinghouses, and health care providers⎯by May 23, 2007 (small healthplans have until May 23, 2008). Learn more about <strong>NPI</strong> and how to apply by v<strong>is</strong>itingwww.cms.hhs.gov/<strong>National</strong>ProvIdentStand/ on <strong>the</strong> CMS Web site.Th<strong>is</strong> page also contains a section <strong>for</strong> Medicare Fee-For-Service (FFS) providers with helpful in<strong>for</strong>mation on<strong>the</strong> Medicare <strong>NPI</strong> implementation. A Countdown Clock <strong>is</strong> now available on th<strong>is</strong> page to remind health careproviders of <strong>the</strong> number of days left be<strong>for</strong>e <strong>the</strong> compliance date; bookmark th<strong>is</strong> page as new in<strong>for</strong>mation andresources will continue to be posted.For <strong>the</strong> online <strong>NPI</strong> application tool, v<strong>is</strong>it https://nppes.cms.hhs.gov or call 1-800-465-3203 to request a paperapplication.For more in<strong>for</strong>mation on private industry <strong>NPI</strong> outreach, v<strong>is</strong>it <strong>the</strong> Workgroup <strong>for</strong> Electronic Data Interchange(WEDI) <strong>NPI</strong> Outreach Initiative website at http://www.wedi.org/npioi/index.shtml on <strong>the</strong> web.V<strong>is</strong>it http://www.georgiamedicare.com often to keep in<strong>for</strong>med!June 2006Vol. 5 No.6
Holiday ScheduleIn observance of Independence Day, Blue Cross Blue Shield of Georgia (BCBSGa) offices will be closedTuesday, July 4, 2006. Offices will reopen at 8:00 a.m. <strong>the</strong> next business day following <strong>the</strong> holiday.PC PRINT Software – Medicare Part AAre you still using <strong>the</strong> Standard Paper Remittance (SPR)? Save TIME and MONEY by taking advantage ofFREE PC PRINT software now available <strong>for</strong> viewing and printing <strong>the</strong> Health Insurance Portability andAccountability Act of 1996 (HIPAA) compliant Electronic Remittance Advice (ERA)!<strong>Provider</strong>s can view and print as many or as few claims as needed. Th<strong>is</strong> will be especially helpful when youneed to print only one claim from <strong>the</strong> remittance advice when <strong>for</strong>warding <strong>the</strong> claim to a secondary payer.Th<strong>is</strong> FREE software can save you time resolving Medicare claim <strong>is</strong>sues.In order to utilize <strong>the</strong> PC PRINT, you will need to receive a HIPAA compliant ERA. Contact our EDIdepartments toll-free at (800) 638-9677 to find out more about PC PRINT or call (888) 883-2720 <strong>for</strong>in<strong>for</strong>mation on how to receive a HIPAA compliant ERA.EDI EnrollmentHealth care partners w<strong>is</strong>hing to submit claims electronically must complete <strong>the</strong> BCBSGa Electronic DataInterchange (EDI) enrollment process be<strong>for</strong>e <strong>the</strong>y can begin submitting claims electronically. To speak withan EDI representative regarding <strong>the</strong> enrollment process, please contact EDI Service at (888) 883-2720,option 1, Monday through Friday between 8:00 a.m. – 5:00 p.m. ET.Medical Data Delivery ReportsAs a reminder, Medical Data Delivery (MDD) reports are available daily after an electronic claimssubm<strong>is</strong>sion. MDD reports will allow you to track claims through <strong>the</strong> system and indicate how claims wereprocessed. Please make <strong>the</strong> necessary corrections and resubmit your claims. All reports should be retrievedafter each transm<strong>is</strong>sion. It <strong>is</strong> <strong>the</strong> vendor’s responsibility to deliver reports to <strong>the</strong> trading partners. If youneed ass<strong>is</strong>tance with retrieving your MDD reports, please contact EDI Services at (888) 883-2720, option 3Monday – Friday between 8:00 a.m. – 4:30 p.m.Erred Claims MessagesThe following <strong>is</strong> a l<strong>is</strong>t of common error messages. BCBSGa encourages you to work with your softwarevendor, clearinghouse or a BCBSGa EDI Services representative to correct <strong>the</strong>se errors. Th<strong>is</strong> will ass<strong>is</strong>t usin more timely claims processing.▪ SUBSCRIBER NOT ON FILE (verify member number on insurance card or verify eligibility prior tosubmitting claims)▪ 2010AA REF02 REF IDEN NOT AUTH (verify provider six-digit EDI number and make certain senderID <strong>is</strong> valid)▪ ISA06 SENDER NOT AUTH (file contains an invalid submitter ID)▪ DIAGNOSIS MISSING OR INVALID (claims must be submitted with <strong>the</strong> correct diagnos<strong>is</strong> code and ifapplicable, code to <strong>the</strong> 4 th or 5 th digit)▪ IDEN CODE NOT AUTH (<strong>Provider</strong> ID code not authorized. File may contain an invalid Tax ID number)Please contact EDI Services at one of <strong>the</strong> following numbers if you have any questions or need additionalin<strong>for</strong>mation. For Product Support call (800) 638-9677 or <strong>for</strong> Vendor Support call (888) 883-2720, option 3.Both numbers are available Monday through Friday between 8:00 AM - 5:00 PM3350 Peachtree Road, NE, Atlanta, GA 30326An Independent Licensee of <strong>the</strong> Blue Cross Blue Shield AssociationJune 2006Vol. 5 No.6
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