National HIPAA Audioconference: Analysis of the National Provider Identifier

National HIPAA Audioconference: Analysis of the National Provider Identifier

Preparing for the NPI Transition

January 11, 2006


Individual Providers If employed by an Organizational Provider

Ask how/if employer plans to enumerate employed providers

What education will be made available? What is required of employed providers? Do I need an NPI?

Preparing for the NPI TransitionProviders

Individual Providers Private or Group Practice

Do I need an NPI? (Most providers will) How will I apply for an NPI? Gather data requirements

https://nppes.cms.hhs.gov/NPPES/Welcome.do Follow instructions carefully Use legal name Use standardized address (NPPES assisted)

Educate yourself on short and long term uses of the NPI

Own the process


Organizational Providers Organize Implementation Team

Implementation Team – Core Members Business Office (PFS) Manager(s) Revenue Cycle Director / Executive Medical Staff / Credentialing Corporate Compliance Officer Information Technology (Clinical and Financial) Managed Care


Implementation Team – Ad Hoc Members Chief Medical Officer Ancillary Department Managers Clinic Managers Health Information Management Human Resources Legal Training and Staff Development / Education


Immediate education Core implementation team

Develop project plan with milestones Identified affected departments/ business units Identify affected Trading Partners and Business

Associates Identify affected processes, policies, and

procedures (Don’t forget Medical Staff By-Laws)


Develop transitional strategies Application Enumeration (Subpart delineation)

Contract Review Regulatory Requirements

Education Employed Providers Medical and Allied Staff Referring Providers


Transitional Strategies (continued) Taxonomy? Disclosure NPI Collection (Dissemination) Validation Testing

The Application Gap Referrals Pharmacy


Information Systems Gap Analyses

NPI Taxonomy Legacy Identifiers Interfaces Reports - Internal and External Document Imaging / Archiving Technologies

Clinical E-Prescribing EHR / EMR

Software updates


Communicate, Ask, Educate Health Plans Software vendors State / Federal Agencies (data submission) Third-party vendors (data submission) Other Business Associates

Preparing for the NPI TransitionPayers

Payers Assemble implementation team

Credentialing Authorizations / Medical Management Claim Processing (Electronic/DDE/Paper) Finance

Remittance Advice Premiums

Beneficiary Enrollment Information Technology


Determine affected processes / departments Plan / product line specific Coordination of Benefits Subparts and the lack of subparts (The Granularity

Issue) Provider Services Legal Provider Contracts Workflow

System Mail Room


Determine affected processes / departments (continued) Web Services Clearinghouses Settlements Reporting Fraud and Abuse

Ten digits of gloriously meaningless pixels / ink


Develop Strategies Conversion / Crosswalk / Other Adjudication Methodologies and related processes

The Application Gap Post-implementation legacy/NPI support

NPI data collection NPI data validation Sequencing of software updates and transactions Testing Implementation schedule


Develop Strategies (continued) Inbound validation

Pharmacy Transactions (PBMs) When is legacy compliant?

The Application Gap Communicate, Ask, Educate

Providers Clearinghouses Software vendors State / Federal Agencies (data submission) Other Business Associates

Preparing for the NPI TransitionVendors

Vendors Claim Clearinghouses Software Vendors Data Clearinghouses Data Warehouses

Develop Implementation Strategies Education Must be ready before customers Software updates Testing


Develop Implementation Strategies (continued) Conversion / Crosswalk / Other NPI validation (Luhn only?) Sequencing of software updates and transactions Testing Implementation schedule

EVERYONE will be ready at different times Support of Dual Identifier Testing Strategy


Ask, Ask, Communicate, Educate Payers Providers Other Trading Partners Other Business Associates


The Application Gap Post-implementation legacy/NPI identifier support

issues


Common Threads Communication Asking Education The Granularity Issue The Application Gap Our patients, beneficiaries, and their families


Michael ApfelChief Privacy Officer

Truman Medical Centers WEDI National Provider Identifier Outreach Initiative

Steering Committee Co-chair, Education and Content Work Group WEDI

National Provider Identifier Outreach Initiative

[email protected]

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National HIPAA Audioconference: Analysis of the National Provider Identifier

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