Update on National Provider Identifier (NPI) Stephanie Anderson, CPC Coordinator of Network Compliance Programs October 2006

Community Care Network of Virginia, Inc. 2 Overview  National Provider Identifier (NPI) May 23, 2005 Applications Accepted: May 23, 2005 Compliance Date to Use ONLY the NPI: May 23, 2007 {Small Health Plans = May 23, 2008}

October 2006Community Care Network of Virginia, Inc. 3 Overview  National Provider Identifier (NPI)  After implementation ~ only the NPI will identify providers in ALL standard transactions Each FQHC will have an organization NPI  ENTITY TYPE 1 Individual Providers will have an individual NPI  ENTITY TYPE 2  UPINs, Medicaid #s, Private Insurer #s, etc. WILL NOT be permitted after May 23, 2007  10-digit identifier - “intelligence-free identifier”

October 2006Community Care Network of Virginia, Inc. 4 Overview  National Provider Identifier (NPI)  Does not expire (certain exceptions apply)  Once the # is assigned, providers must furnish updates to the data within 30 days of any changes CCNV has the information to update these applications IF we applied for the NPI.  Provider’s should have a copy of their official NPI notification or know how to get it.

October 2006Community Care Network of Virginia, Inc. 5 CCNV NPI Process To Date:  Began applying for Network Providers’ NPIs in November 2005 Applications are made for Organization & Individual Providers  Use Credentialing Database for current providers  Credentialing Department applies for the NPI once they receive a CCNV Credentialing Application  Center Contacts are sent NPI notifications via or US mail

October 2006Community Care Network of Virginia, Inc. 6 CCNV NPI Process To Date:  CCNV applies for NPIs for: Organization (Entity Type 1)  Medical Center  Pharmacy Individual Provider (Entity Type 2)  (MD, DO, PA, NP, LCSW, Dentist, Pharmacist, etc.)  Center site must be his/her primary location

October 2006Community Care Network of Virginia, Inc. 7 CCNV NPI Process To Date:  Current Network Providers should have: An assigned NPI from the NPPES (official notification) on file at CCNV and Center OR An application in process, if provider is new to the CCNV Network OR An NPI official notification sent to us from a previous employer

October 2006Community Care Network of Virginia, Inc. 8 NPI Application Tidbits  Contact Person listed on Application Must be updated when provider changes practice locations NPPES will only give information to contact person or provider s will only be sent to contact person’s listed  Log-on/password details Very important to update provider information

October 2006Community Care Network of Virginia, Inc. 9 NPI Application Tidbits  What are Taxonomy Codes? Numbers assigned under the HIPAA provisions to health care providers, Encoding process that recognizes specialty Facilitates electronic billing  Every NPI application must have a taxonomy code (ex. FQHC = 261QF0400X 

October 2006Community Care Network of Virginia, Inc. 10 NPI Implementation Timeline Electronic Claims

October 2006Community Care Network of Virginia, Inc. 11 CMS NPI Education Resource  on.asp#TopOfPage

October 2006Community Care Network of Virginia, Inc. 12 Additional Resources Available  NPI Final Rule - January ess.gpo.gov/2004/pdf/ pdf  CMS NPI Resource Center

October 2006Community Care Network of Virginia, Inc. 13 Questions??

October 2006Community Care Network of Virginia, Inc. 14 Thank You ! Stephanie Anderson, CPC Community Care Network of Virginia, Inc Paragon Place Suite 630 Richmond, VA (T) (804) x