5222 East Baseline Road, Suite 101 Gilbert, Arizona 85234

 

Main 480/324/2765 Toll free 800/333/4747 www.Lytec.com

August 29, 2006

 

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. On January 23, 2004, the Secretary published a Final Rule adopting the National Provider Identifier (NPI) for this requirement. All HIPAA covered healthcare providers, whether they are individuals or

organizations, must obtain an NPI to identify themselves in HIPAA standard transactions. Once established, a provider's NPI will not change. The NPI remains with the provider regardless of job or location changes.

Effective May 23, 2007, the Centers for Medicare & Medicaid Services (CMS) claims processing systems will only accept claims that include NPI numbers. At the same time, all providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use the NPI to identify covered healthcare providers in standard transactions.

Now is the time to prepare and to ensure that providers using Lytec can continue to send electronic claims after the May 2007 deadline! The link to apply for an NPI number is

http://nppes.cms.hhs.gov/N PPES/Welcome.do.

NPI Timeline Schedule

Medicare's implementation involving acceptance and processing of transactions with the NPI will occur in separate stages, as shown in the table below:

May 23, 2005 - Jan 2, 2006: Providers should submit Medicare claims using only their existing Medicare numbers. They should not use their NPI numbers during this time period. CMS claims processing systems will reject and not process any claim that includes an NPI during this phase.

Jan 3, 2006 - Oct 1, 2006:        Medicare systems will accept claims with an NPI, but an existing legacy Medicare number must also be on the claim. Note that CMS claims processing systems will reject and not process any claim that includes an NPI only.

Medicare will be capable of sending the NPI as primary provider identifier and legacy identifier as a secondary identifier in outbound claims, claim status response, and eligibility benefit response electronic transactions.

Oct 2, 2006 - May 22, 2007: CMS systems will accept an existing legacy Medicare billing number and/or an NPI on claims. If there is any issue with the provider’s NPI and no Medicare legacy identifier is submitted, the provider may not be paid for the claim.

Therefore, Medicare strongly recommends that providers, clearinghouses, and billing services continue to submit the Medicare legacy identifier as a secondary identifier.

Medicare will be capable of sending the NPI as primary provider identifier and legacy identifier as a secondary identifier in outbound claim, claim status response, remittance advice (electronic but not paper), and eligibility response electronic transactions.

May 23, 2007 – Forward:         CMS systems will only accept NPI numbers from all providers completing electronic transactions, healthcare clearinghouses, and large health plans. Small health plans have an additional year to be NPI compliant.


 

What does this mean for Lytec users?

In order to submit claims electronically after May 23, 2007 and in order to generate CMS 1500 printed claims, Lytec customers must upgrade to Lytec 2006. Although previous versions of Lytec include a field that can store an NPI, these versions do not include software that enables electronic claims submission with the required NPI nor will they be able to produce paper claims using the new required form. The N PI-ready features will be available to providers using Lytec 2006 via an NPI update we will release in early 2007. These features will also be included within Lytec 2007, which will be released early November 2006.

What about Direct Modules?

Per-Se will continue to support the published list of Direct Modules for Lytec 2006. Note that as we approach the Lytec 2008 release, we will no longer support Lytec 2006 or the Direct Modules associated with Lytec 2006.

What about our Clearinghouse?

Both the Stratus and the Phoenix platforms will support the mandated NPI changes. Please keep in mind that the Phoenix platform supports many additional payers, more remittance connections and Electronic Eligibility Verification services. Although the Stratus platform supports the NPI changes, customers must install Lytec 2006, NPI update or Lytec 2007 in order to be N PI-ready.

To view additional details about our clearinghouse’s NPI Strategy, please click on the following link to get additional details http://www.medavanthealth.com/npi.aspx.

Additional information and bulletins can be found at the Centers for Medicare and Medicaid Services website at http://www.cms.hhs.gov/default.asp?.

 

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