Ask the Contractor Teleconference
September 27, 2006
Topic: National Provider Identifier
Questions
& Answers
Contractor
General Comment: Please note that the transcript of these
questions was edited to allow for the greatest dissemination of information to
the widest audience. While we received
many questions on specific circumstances regarding the issue of subparts, the
Contractor is not permitted to advise on this issue. Rather we refer you to the CMS Web NPI site
which offers information and assistance on the topic of subparts.
Question 1:
Do optical shops need a NPI number?
Answer 1: All HIPAA covered healthcare providers, whether they
are individuals or organizations, must obtain an NPI for use to identify
themselves in HIPAA standard transactions.
Question 2: What if the doctor is an individual sole proprietor and already has an
individual NPI, does he need a second NPI if he is reimbursed under his tax
I.D. rather than his social security number?
Do I need to get another one or would that only confuse matters? What if a medical practice has a corporation
with one tax I.D. but has two different locations, do I need one or two NPI
numbers? What if…?
Answer 2: The
National Provider Identifier (NPI) Final Rule requires health care providers
who are organizations and who are covered entities under HIPAA to determine if
they have "subparts" that should be assigned NPIs.
The
NPI Final Rule provides guidance to health care providers in making those
determinations. The Centers for Medicare and Medicaid Services (CMS) has
communicated to the Provider Enrollment staff at the contractors, the Medicare
program's expectations concerning the determination of subparts for NPI
assignment purposes. CMS has posted a document describing the subpart concept
and its relationship to the way in which Medicare enrolls its organization
providers at http://www.cms.hhs.gov/NationalProvIdentStand/06_implementation.asp#TopOfPage.
Question 3: How do I contact the NPI enumerator FOX
systems?
Answer 3: They may be reached by
phone at: 1-800-465-6059, by email at customerservice@npienumerator.com
or by mail at:
NPI Enumerator
PO Box 6059
Fargo, ND 58108-6059
Question 4: What should be placed on line 4 on
the taxonomy number?
Answer 4: We
cannot speak for the NPI application because we are not the administrator. Please address this question to Fox Systems.
Question 5: Is there a website to look up NPI
numbers?
Answer 5: The
date for the dissemination of information is not available yet for the
NPI. We’re still waiting for the final
rule from the CMS.
Question 6: Are all of the Medicare numbers going
away?
Answer 6: Yes. The Medicare legacy numbers and UPINs will
all be replaced with NPI numbers. Claims
received on and after May 23rd 2007 with Medicare numbers will be
rejected.
Question 7: Is there any way to get a duplicate
Letter of Notification for the NPI numbers?
Answer 7: This
can be done by having the person whose number it is contact Fox Systems
directly.
Question 8: I applied over a month ago for two of
my physicians to get their individual NPI numbers I received my confirmation on one of the two
and haven’t heard anything on the other and it’s been over a month. Do I need to contact Fox Systems to put a
trace on that so that I avoid duplicate applications?
Answer 8: Yes,
they assign all the NPI numbers and you may contact them directly.
Question 9: What is the process to submit NPI
numbers on electronic claims for currently enrolled providers with Medicare?
Answer 9: Please
check with your software vendor to find where the NPI information is input.
Question 10: If temporary personnel from an outside
agency come in and provide service, do we need to input their individual NPIs
on each of those bills?
Answer 10: If
they are providing the services, yes.
Question 11: Regarding the use of individual NPI
along with the group NPI, which boxes on
the revised 1500 Claim Form would the individual use if they are billing within
a group?
Answer 11: On
the new revised form, in billing by paper, use the individual National Provider
Identifier in Item 24J and then in Item 33A use the Group National Provider
Identifier number.
Question 12: Does the individual NPI need to be attached
to a tax I.D.?
Answer 12: No,
it could be under the social security number if the doctor is a Sole Proprietor.
Question 13: What are the time lines for using the
NPI when submitting claims to Medicare?
Answer 13: For
electronic claims:
From
now until May 22nd 2007, providers may submit with
·
Both Medicare
legacy numbers and NPI numbers
·
Only Medicare
legacy numbers
·
Only NPI numbers
May
23rd 2007 and after:
·
Only NPI numbers
For
paper claims:
From
now until December 31st 2006:
·
Only Medicare
legacy numbers
January
1st 2007 – May 22nd 2007
·
Both Medicare
legacy numbers and NPI numbers
·
Only Medicare
legacy numbers
·
Only NPI numbers
May
23rd 2007 and after
·
Only NPI numbers
Question 14: If a Clearinghouse needs to know what
fields to input the NPI information for electronic claims, who may they
contact?
Answer 14: In
the format in the electronic billing, there is a separate location for both the
NPI number and the Legacy numbers. So if
the Clearinghouse has any questions, they should contact the EDI department and
they can refer them to the appropriate location within the HIPAA format.
Question 15: Should NPI information be submitted to
Medicare’s Written Inquiries?
Answer 15: No,
that is not necessary. NPI letters or
855 forms do not need to be submitted to the contractor only to indicate a new
NPI number. The crosswalk will happen
through the submission of claim forms.
That’s
why it’s asked that providers bill with both the Medicare Legacy Numbers and
the NPI numbers through May 22, 2007, because the carrier will use this
information to do the proper crosswalk of your NPI numbers to your Legacy
Numbers.
10/19/2006