NPI Resources - Information Updates
Third Party
- Download from this site: Third Party Implementation Schedules Compiled by FDS - Use this link to view or download the PDF.
CMS Resources
- Guideline Clarification: CMS clarifies Guidelines for National Provider
Identifier Deadline Implementation. Visit
http://www.cms.hhs.gov/NationalProvIdentStand/
- Contract & Enrollment Data on MA and Part D Plans
(new CMS web site): The Centers for Medicare & Medicaid Services (CMS)
announces the launch of the
new section on the CMS public website to house contract and enrollment data about MA and Part D
plans. This site provides a plan directory and an MA claims processing contact directory.
These directories contain basic information about the contract as
well as contact information for the plan itself. CMS will update
these directories on a monthly basis.
- Frequently Asked Questions (FAQs) Posted: CMS has posted new NPI FAQs
on its website. To view these FAQs, please go to the
CMS dedicated NPI webpage and
click on "Educational Resources." Scroll down to the section that says "Related Links Inside
CMS" and then click on "Frequently Asked Questions."
Click on the
arrows next to "Date Updated."
- NPI Standard CMS Communications: See 'What's New?' at
http://www.cms.hhs.gov/NationalProvIdentStand/02_WhatsNew.asp
- NPI Compliance Contingency Guidance Highlights: This PDF download is available
at http://www.cms.hhs.gov/
- NPI Contingency Policy Released: As most health providers know, May 23, 2007
is the deadline for covered entities to comply with HIPAA's National Provider Identifier (NPI) standards.
Recognizing that transactions often require the participation of two covered entities and that non-compliance by one covered entity may put the second covered entity in a difficult position, CMS released NPI guidance to allow contingency plans to be implemented by covered entities making a good faith effort to comply with the NPI provisions.
These contingency plans may include acceptance of legacy provider numbers on HIPAA transactions. Contingency plans may not extend beyond May 23, 2008, but covered entities may elect to end their contingency plans sooner. Use this link to go to CMS' main page, then download the "NPI Compliance Contingency Guidance" PDF from the "CMS Highlights" section on the right side of the page.
State Resources
- California Medi-Cal ... Important NPI Time Frame Changes:
The California Department of Health Services (CDHS) anticipates Medi-Cal will not be implementing all
NPI system changes on May 23, 2007.
Use this link to read about the Time Frame Changes on the California Medi-Cal web site.
- North Carolina - NPI and the Prescriber Edit: Beginning May 18, 2007,
providers will no longer be able to submit Medicaid provider numbers on claims due to the implementation
of NPI.
In addition, pharmacy providers will also need to submit the prescriber's NPI in the prescriber field.
It would be in the pharmacists' best interest to start requesting the prescriber's NPI number
now and updating their systems accordingly.
N.C. Medicaid will allow the pharmacy to submit the pharmacy provider NPI number in the prescriber field for a period of at least one month post implementation. This is intended to give the pharmacists additional time to obtain the prescriber's NPI number. If you use this option be sure to update your system once the actual NPI number is obtained or future refills may deny.
- South Carolina: In order to experience a smooth
transition, South Carolina Medicaid has required that providers submit their
NPI to SCDHHS prior to the above date. Beginning April 16, 2007, Pharmacy Services
providers should submit the pharmacy's NPI in the service provider ID field (NCPDP
field number 201-B1)on pharmacy claims.
Use this link to download a South Carolina training tutorial which will
take you through the whole NPI submission process. (PowerPoint Presentation, 4,774 KB;
requires Internet connection).
- Tennessee: Effective April 24, 2007, TennCare will begin the
transition to the National Provider Identifier (NPI) requirement for identification of the
dispensing pharmacy on pharmacy claims. Download the
TennCare Pharmacy Program 070322 PDF from this web site.
- Texas: Texas [Medicaid] will have a transition period for pharmacy NPI from 4/23 until 5/22/07. Texas will no longer accept pharmacy NCPDP for service provider ID on or after 5/23/07. At this point in time, or until CMS posts their dissemination rules, Texas will not accept the prescriber NPI on the claim request for provider ID. Texas will continue to require the state issued prescriber license number.
Other Resources
- WEDI Upcoming Events:
See http://www.wedi.org/npioi/index.shtml
- Express Scripts: If a pharmacy does not have its NPI on file with Express
Scripts prior to the compliance date, claims will be rejected after May 23, 2007 until they receive the
pharmacy's number.
Again, this is the pharmacy's number, not the pharmacist's number.
Download the Express Scripts NPI Bulletin 2/2/07 from this web site.
Getting an NPI is easy and free.
Additional information about the NPI Number requirement may be found via the following links.
- http://www.cms.hhs.gov/NationalProvIdentStand
- FDS' NPI Resource page 1 and page 2 on this web site.
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