It’s time to apply for a national provider identifier
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Posted May 9, 2006 |
By Arlene Furlong Dentists who want to avoid disruptions in claim payments next year can apply for a national provider identifier now.
The NPI is a unique, standard identification number for health care providers. Its use will be required on HIPAA standard transactions. The most common HIPAA standard electronic transactions used by dentists are electronic claims and eligibility inquiries. (HIPAA standard transactions do not include stand-alone fax machines or voice communications via telephone.) For a complete list of standard transactions, see the article "HIPAA 20 Questions" in the April 2003 issue of ADA Legal Adviser (ADA members only).
The 10-digit NPI number will replace the current provider identification information used—usually called legacy identifiers. Legacy identifiers can be dental plan-specific identifiers, license numbers and Social Security numbers.
Like other regulations under the Health Insurance Portability and Accountability Act of 1996 (electronic transactions, privacy and security), the NPI applies to all health care providers and provider organizations that transmit HIPAA standard electronic transactions—either directly or through a vendor or clearinghouse.
Those required by federal law to include NPIs on electronic transactions must do so by no later than May 23, 2007. Enforcement will come under the supervision of the Department of Health and Human Service's Centers for Medicare & Medicaid Services
Importantly, even dentists who do not use any HIPAA standard electronic transactions may encounter health plans that require an NPI on paper claims, according to the ADA Department of Dental Informatics.
In addition, state laws could require dentists to obtain NPIs even if they are not HIPAA covered entities. Minnesota already does this. For these reasons, the ADA is encouraging all dentists to consider obtaining an NPI.
"Since the provider identifier is at the heart of the billing and claims payment process for every covered entity, successful implementation of the NPI and its use in internal systems and external transactions will be important for continued reimbursement," says Jean Narcisi, director of the ADA Department of Dental Informatics. "The NPI represents not only a new identifier, but may require practice management systems changes in many dental offices."
Dental informatics specialists believe the NPI has many advantages over identifiers now in use, among them:
- providers, including dentists, will not have to maintain multiple, arbitrary identifiers required by dental plans, nor remember which number to use with which plan;
- electronic claims function more efficiently by introducing another element of standardization to processing;
- it contains no vital intelligence about the provider's name, location, specialty, patients or qualifications.
The ADA Department of Dental Informatics suggests that dentists begin identifying key partners who will need their NPI information. In essence, this means any business that needs an NPI from a dentist or dental practice to facilitate payment of benefits and/or delivery of health care. These include, but are not limited to dental plans, clearinghouses, systems vendors, billing services and other health care providers. Laboratories and pharmacists should also be included in the health care provider category.
After identifying key partners, dentists can request their dental practice management system vendors to update their systems to include the NPI and conduct tests to ensure that each dental plan is receiving the necessary information to process claims efficiently. Dentists who submit electronic claims to a clearinghouse can ask if the clearinghouse is conducting NPI tests in preparation of the May 23, 2007, compliance deadline. In addition, the clearinghouse may need legacy identifier information in order to support the transition to the NPI. Look to future issues of the ADA News for updates on NPI testing and implementation.
For more information from ADA.org, go to www.ada.org/goto/npi. Questions, comments or concerns may be directed to NPI@ada.org. Those without e-mail or members who would prefer to talk to a staff member may call the ADA directly and ask for Ext. 4608.
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