Update on Use of National Provider Identifiers

The compulsory use of the new National Provider Identifier (NPI) is still set to begin for most health entities on May 23. Much like what happened with the short time frame for the implementation of the Medicare Part D prescription drug benefit, a number of problems have not been resolved yet. Among them: Health plans need to build crosswalks between the legacy provider identifiers in their systems and the providers' new NPIs, physicians need to obtain the NPIs of the physicians with whom they consult so billing can be done properly, and pharmacies will need the NPIs of prescribing physicians to be able to submit valid claims. Because of such issues, a movement is afoot to delay implementation until more testing of the system has been done. However, since there is no assurance that there will be a postponement, protect yourself—get your NPI before May 23 so you can be certain that you or your patients will be able to be reimbursed by insurers after that date. You will need an NPI even if you do not do electronic transactions and are not covered by the Health Insurance Portability and Accountability Act. For instance, you will be required to have an NPI in order to opt out of Medicare.

The Centers for Medicare and Medicaid Services (CMS) has issued a new form, CMS-1500 (08-05), for filing claims using the NPI. The original deadline of April 1 for mandatory use of the new form has been extended until at least June 1 because some of the forms contained errors that had to be corrected. To be sure you have the new form, on the bottom of the form you should see“ Approved OMB-0938-0999 FORM CMS-1500 (08-05).”