National HIPAA Audioconference: Analysis of the National Provider Identifier Preparing for the NPI Transition January 11, 2006

Preparing for the NPI Transition Individual Providers If employed by an Organizational Provider Ask how/if employer plans to enumerate employed providers What education will be made available? What is required of employed providers? Do I need an NPI?

Preparing for the NPI Transition Providers Individual Providers Private or Group Practice Do I need an NPI? (Most providers will) How will I apply for an NPI? Gather data requirements   Follow instructions carefully  Use legal name  Use standardized address (NPPES assisted) Educate yourself on short and long term uses of the NPI Own the process

Preparing for the NPI Transition Providers Organizational Providers Organize Implementation Team Implementation Team – Core Members Business Office (PFS) Manager(s) Revenue Cycle Director / Executive Medical Staff / Credentialing Corporate Compliance Officer Information Technology (Clinical and Financial) Managed Care

Preparing for the NPI Transition Providers Implementation Team – Ad Hoc Members Chief Medical Officer Ancillary Department Managers Clinic Managers Health Information Management Human Resources Legal Training and Staff Development / Education

Preparing for the NPI Transition Providers Immediate education Core implementation team Develop project plan with milestones Identified affected departments/ business units Identify affected Trading Partners and Business Associates Identify affected processes, policies, and procedures (Don’t forget Medical Staff By-Laws)

Preparing for the NPI Transition Providers Develop transitional strategies Application Enumeration (Subpart delineation) Contract Review Regulatory Requirements Education Employed Providers Medical and Allied Staff Referring Providers

Preparing for the NPI Transition Providers Transitional Strategies (continued) Taxonomy? Disclosure NPI Collection (Dissemination) Validation Testing The Application Gap Referrals Pharmacy

Preparing for the NPI Transition Providers Information Systems Gap Analyses NPI Taxonomy Legacy Identifiers Interfaces Reports - Internal and External Document Imaging / Archiving Technologies Clinical E-Prescribing EHR / EMR Software updates

Preparing for the NPI Transition Providers Communicate, Ask, Educate Health Plans Software vendors State / Federal Agencies (data submission) Third-party vendors (data submission) Other Business Associates

Preparing for the NPI Transition Payers Payers Assemble implementation team Credentialing Authorizations / Medical Management Claim Processing (Electronic/DDE/Paper) Finance  Remittance Advice  Premiums Beneficiary Enrollment Information Technology

Preparing for the NPI Transition Payers Determine affected processes / departments Plan / product line specific Coordination of Benefits Subparts and the lack of subparts (The Granularity Issue) Provider Services Legal Provider Contracts Workflow System Mail Room

Preparing for the NPI Transition Payers Determine affected processes / departments (continued) Web Services Clearinghouses Settlements Reporting Fraud and Abuse Ten digits of gloriously meaningless pixels / ink

Preparing for the NPI Transition Payers Develop Strategies Conversion / Crosswalk / Other Adjudication Methodologies and related processes The Application Gap Post-implementation legacy/NPI support NPI data collection NPI data validation Sequencing of software updates and transactions Testing Implementation schedule

Preparing for the NPI Transition Payers Develop Strategies (continued) Inbound validation Pharmacy Transactions (PBMs) When is legacy compliant? The Application Gap Communicate, Ask, Educate Providers Clearinghouses Software vendors State / Federal Agencies (data submission) Other Business Associates

Preparing for the NPI Transition Vendors Vendors Claim Clearinghouses Software Vendors Data Clearinghouses Data Warehouses Develop Implementation Strategies Education Must be ready before customers Software updates Testing

Preparing for the NPI Transition Vendors Develop Implementation Strategies (continued) Conversion / Crosswalk / Other NPI validation (Luhn only?) Sequencing of software updates and transactions Testing Implementation schedule EVERYONE will be ready at different times Support of Dual Identifier Testing Strategy

Preparing for the NPI Transition Vendors Ask, Ask, Communicate, Educate Payers Providers Other Trading Partners Other Business Associates

Preparing for the NPI Transition Vendors The Application Gap Post-implementation legacy/NPI identifier support issues

Preparing for the NPI Transition Common Threads Communication Asking Education The Granularity Issue The Application Gap Our patients, beneficiaries, and their families

Preparing for the NPI Transition Michael Apfel Chief Privacy Officer Truman Medical Centers WEDI National Provider Identifier Outreach Initiative Steering Committee Co-chair, Education and Content Work Group WEDI National Provider Identifier Outreach Initiative