CCNV 2ND ANNUAL CLIENT CONFERNCE NATIONAL PROVIDER IDENTIFIER AND YOUR ACCOUNTS RECEIVABLE Diane Harris 10/16/06.

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Presentation transcript:

CCNV 2ND ANNUAL CLIENT CONFERNCE NATIONAL PROVIDER IDENTIFIER AND YOUR ACCOUNTS RECEIVABLE Diane Harris 10/16/06

DISCUSSION w Getting started w National Provider Identifier (NPI) Tips w Preparing your billing staff for NPI

w UNDERSTAND HOW THE INTRODUCTION OF A NATIONAL IDENTIFICATION NUMBER FOR ALL PROVIDERS OF MEDICAL SERVICES WILL IMPACT YOUR FACILITY w COMMUNICATE WITH HEALTH PLANS OUTSIDE OF THE CCNV NETWORK TO DETERMINE THEIR NPI IMPLEMENTATION GUIDELINES

w THE NPI IS REQUIRED FOR ALL PROVIDERS OF MEDICAL SERVICES w LOCUM TENENS AND CONTRACT PROVIDERS WHO PROVIDE MEDICAL SERVICES AT YOUR FACILITY WILL BE REQUIRED TO PRESENT THEIR INDIVIDUAL NPI’S

w YOUR BILLING STAFF WILL NEED TO KNOW WHAT TO DO IF ANOTHER PROVIDER’S NPI IS NEEDED AND IS UNKNOWN (e.g., referred services) w SUGGESTION: COMPILE YOUR REFERRING PHYSICIAN NPI’S SOONER THAN LATER

w NPI’S WILL BE USED FOR ALL BILLING TRANSACTIONS ALL MEDICARE PRODUCTS ALL MEDICAID PRODUCTS ALL COMMERCIAL PRODUCTS w CLAIMS WILL BE REJECTED EFFECTIVE 5/23/07 WITHOUT NPI’S REJECTION CODE WILL BE: 16 INDICATING THE CLAIM LACKS INFORMATION THAT IS NEEDED FOR ADJUDICATION

w IF YOU ARE CURRENTLY RECEIVING MULTIPLE REMITTANCES FROM CARRIERS DUE TO MULTIPLE PROVIDER ID’S THIS WILL CEASE WITH THE NPI w CMS RECOMMENDS RECEIVING YOUR FUNDS ELECTRONICALLY VIA ELECTRONIC FUND TRANSFER OR EFT. THIS IS THE CURRENT TREND WITH MOST MAJOR CARRIERS

w COMPANION TECHNOLOGIES IS IN THE PROCESS OF UPDATING YOUR SOFTWARE PROGRAMMING FOR THE NEW 1500 FORM (8/05) AND THE NEW UB FORM (04) TO INCLUDE ELECTRONIC SUBMISSION w ECLINICAL WILL ALSO BE PREPARED FOR THE NEW HIPPA FORMAT PRIOR TO 5/23/07 THE 1500 FORM (8/05) IS READY AND ON SALE THE MEDICAID FORM IS READY AND IN USE THE UB FORM (04) IS NOT YET READY FOR RELEASE

w CONTINUE TO USE BOTH YOUR LEGACY NUMBERS AND NPI NUMBERS ON CLAIMS UNTIL 5/23/07. THIS WILL ALLOW THE CROSS WALK OF DATA TO OCCUR FOR YOUR FACILITY w CREATE A PROCESS TO SHARE YOUR NPI’S WITH BUSINESS PARTNERS FOR BILLING PURPOSES( HOSPITALS, E- PRESCRIBING, SKILLED NURSING FACILITIES)

1500FORM1500FORM

U B 04

w PREPARATION IS THE KEY TO SUCCESS WITH THE NPI AND YOUR AR! w THIS IS A NEW PROCESS FOR INSURANCE CARRIERS, PROVIDERS AND SOFTWARE VENDORS, ARE YOU READY?