It's time to get your NPI
ADA urges testing before May 23 deadline
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Posted March 5, 2007 |
By Arlene Furlong "Anxiety over the NPI is a lot greater than dealing with its reality."
So says Dr. Alan E. Friedel, chair of the Council on Dental Practice. He's among some 94,266 dentists the ADA estimates will be ready to file electronic transactions with their national provider identifiers on May 23, as required by the federal Health Insurance Portability and Accountability Act.
According to the ADA Department of Dental Informatics, the only dentists who have anything to worry about related to the NPI are those who aren't ready for the deadline. They may face a potential disruption in claim payments.
To be ready, dentists have to first obtain an NPI and then successfully test those numbers with business partners who will need it to pay benefits or facilitate delivery of health care.
"As soon as dentists obtain an NPI, they should begin identifying key partners so together they can determine testing strategies," says Jean Narcisi, director of the ADA Department of Dental Informatics.
Key partners are any businesses that need an NPI from a dentist or dental practice to facilitate payment of benefits and/or delivery of health care. These include dental plans, clearinghouses, systems vendors, billing services and other health care providers. Laboratories and pharmacists should be included with the group of key partners who may need NPI information.
Although these entities may contact dentists first to request their NPIs, dentists will want to know the status of all of their business partners' readiness to comply with the NPI requirement.
For dentists, the first business partner to contact may be their practice management system vendor. While many practice management systems will have the capability of including the NPI, others may still be developing it. Dentists should know what their vendors' capabilities are. Ms. Narcisi explains that dentists and payers may not know if there is a problem with an NPI until it is tested.
"If the number is manually inserted, it has to be entered correctly. If it's added to the practice management system and is automatically included on the claim form, it needs to be verified that it was entered correctly and that it can be transmitted correctly," says Ms. Narcisi. "The best way to determine this is to allow time for testing."
During the initial testing period, some payers may request that dentists submit both their current identifiers and their NPIs, so payers can couple the NPI in the claims system with the legacy identifiers.
Dentists who have already begun testing have learned that an incorrect NPI may not be linked with their current legacy numbers for proper identification and may be returned by payers for correction and resubmission.
After the NPI is successfully received it will no longer be necessary for dentists to send in both identifiers after May 23, 2007. Dentists will be able to send in only the NPI on future transactions.
According to the ADA Department of Dental Informatics, the NPI may have some advantages over identifiers now in use. For example, once implemented across the health care industry, the NPI will be accepted by all dental plans as a valid provider identifier on electronic dental claims and other standard electronic transactions. Dentists will not have to maintain multiple, arbitrary identifiers required by dental plans, nor will they have to remember which number to use with which dental plan. Dental informatics experts believe the NPI may improve transaction acceptance rates by introducing an important element of standardization to electronic transactions.
Some dental plans are already requesting NPIs to begin testing. Look to an upcoming issue of the ADA News to learn how far along dental plans, clearinghouses and dentists are in that process.
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