NPI Registry Is Up and Running
WASHINGTON–After months of preparation, the eagerly awaited
Internet registry of National Provider Identification numbers and
other health care provider data is operational.
The system allows health care providers to locate their referral
sources’ NPI numbers and other critical data in order to submit
compliant claims to Medicare. It was established by CMS as a means
of complying with provisions in the Health Insurance Portability
and Accountability Act.
The registry should be a help to both providers and HHS, CMS
said in a notice published in the May 30 Federal Register.
“Internet availability eliminates the need for entities to submit
initial and ongoing requests for data to HHS and for HHS to process
and respond to each of those requests,” the notice said.
The data, which discloses only information obtainable through
the Freedom of Information Act, is available in downloadable files
and in a query-only database. Users can query by NPI or provider
name to access the information, and data will be updated monthly.
There is no charge to access the registry, and no user IDs or
passwords are required.
“It is still good for providers to try and obtain the
information from the physicians at the time of referral, but if
that is not a possibility or the intake person has forgotten, the
registry is a great tool,” said Sarah Hanna, vice president of ECS
Billing & Consulting in Tiffin, Ohio. “Our medical
documentation department is using it and finding it to be
helpful.”
With the registry operational, it is critical that providers
include NPI numbers on their claims, officials said. “Between the
period of Sept. 3, 2007, and Oct. 29, 2007… Part B carriers and
DME MACS will begin to turn on edits to validate the NPI/[legacy
number] pairs submitted on claims. If the pair is not found on the
Medicare NPI crosswalk, the claim will reject,” CMS said in a
communication to providers.
The agency also stressed the importance of validating that the
National Plan and Provider Enumeration System has all NPI and
legacy numbers a provider intends to use on claims. “If the
information is different in the two systems, there is a very good
chance your claim will reject,” CMS said.
CMS said Medicare contractors might contact providers that have
not been submitting their NPIs or those with a high volume of
rejections in order to validate NPPES information.
The
registry.
A
Medlearn Matters article on using the NPI correctly on Part A and
Part B claims.
For information on
using the NPI on the new CMS 1500 and UB-04 forms.
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