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March 2007

National Provider Indentifier (NPI)

What’s all this you’re hearing about NPI? What is it? And how does it impact documentation for long-term care providers?

The National Provider Identifier (NPI) is a unique identification number for a health care provider that will be used by all health plans. A health care provider is defined as an individual, group or organization that provides medical or other health services or supplies.

Health care providers, all health plans and health care clearinghouses will use the NPI in the administrative and financial transactions specified by HIPAA, such as billing forms. The Centers for Medicare and Medicaid Services (CMS) revised two of their claim forms to accommodate the NPI: the CMS 1500 and the UB-04 (which replaced the UB-92).

CMS recently announced they have decided to extend the acceptance period of the Form CMS-1500 (12-90) version beyond the original April 1, 2007 deadline tentatively to June 1, 2007. CMS discovered they had incorrectly formatted the revised form, and they have decided to delay the transition date. The UB-04 forms are still required to have the NPI on all claims by May 23, 2007. As a warning, providers failing to meet requirements after the deadline can expect denials and other huge headaches. Briggs has both versions of the forms available now in the correct format.

To view Briggs CMS 1500 or UB-04 forms, click here.

To view CMS Breaking News, click here.

Karen Merk, RN, BS, CRNAC
Clinical Consultant
Briggs Corporation

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