The NPI is here. The NPI is now. Are you using it?
Page last Modified on Februar 27, 2008
DMAS - NPI Compliance - May 23, 2008
February 27, 2008 Update
Urgent – Utilization of National Provider Identifier (NPI)
With Virginia Medicaid Pharmacy Claims Processing.
January 14, 2008 Update
Attached you find the most recent letter sent to providers who are not using their NPI.
ARE YOU USING YOUR NPI?
September 14, 2007 Update
The NPI Registry and the downloadable file are now available.
To view the Registry, visit
https://nppes.cms.hhs.gov/NPPES/ on the web. The downloadable file
is available
at http://nppesdata.cms.hhs.gov/on the web.
August 7, 2007 Update
Dissemination of data from the National Plan and Provider Enumeration System (NPPES) to begin September 4, 2007
NPPES health care provider data that are disclosable under the Freedom of Information Act (FOIA) will be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS). In accordance with the e-FOIA Amendments, CMS will be disclosing these data via the Internet. Data will be available in two forms:
- A query-only database, known as the NPI Registry.
- A downloadable file.
CMS is extending the period of time in which enumerated health care providers can view their FOIA-disclosable NPPES data and make any edits they feel are necessary prior to the initial disclosure of the data.
In order to ensure edits are reflected in the NPI Registry when it first becomes operational and in the first downloadable file, health care providers need to submit their edits no later than Monday, August 20, 2007. Health care providers who submit edits on paper need to ensure that they are mailed in time for receipt by the NPI Enumerator by that date.
CMS will be making FOIA-disclosable NPPES health care provider data available beginning Tuesday, September 4, 2007. The NPI Registry will become operational on September 4 and the downloadable file will be ready approximately one week later.
Health care providers should refer to the document entitled, “Information on FOIA-Disclosable Data Elements in NPPES,” dated June 20, 2007 (found on the CMS NPI web page at http://www.cms.hhs.gov) for assistance in making their edits.
July 26, 2007 Update
DMAS Contingency Period
During this testing and implementation phase for the NPI, providers should pay close attention to information from health plans and clearinghouses to understand how claims are being processed and what providers should be doing to assure no disruption in payment. Providers should also ensure that the information they are submitting on a claim is what is being transmitted to each health plan by the billing vendors or clearinghouses who may be submitting the claims on their behalf.
National Plan and Provider Enumeration System (NPPES) FOIA-Disclosable
Data to be Available on August 1, 2007
The NPI Registry, a query-only database, will be operational on August 1, 2007. The NPI Registry will operate in a real-time environment. This means that FOIA-disclosable data for newly enumerated providers, as well as updates and changes to enumerated providers’ FOIA-disclosable data, will be available in the NPI Registry as that information is applied to NPPES. The NPI Registry will enable a user to query by, for example, NPI or provider name, and will return a list of all NPPES records that meet the query specifications. About a week later, CMS will make available a file for downloading that will contain the FOIA-disclosable NPPES data of enumerated health care providers. CMS will be furnishing more information about data dissemination, and will make that information available on the CMS NPI web page at: www.cms.hhs.gov.
Fact Sheet for Providers who are Sole Proprietors
http://www.cms.hhs.gov/
Group Practices and their members need NPIs for Medicaid Purposes
Group practices that bill Medicaid, either electronically or on paper, are required to enroll with and use NPIs to identify themselves as the Billing Providers in Medicaid claims. Providers who are identified as Rendering Providers on claims must be enrolled in Medicaid and be identified by NPIs. Therefore, group practices that are enrolled in Medicaid will want to ensure that their members (physicians or other practitioners) obtain NPIs in order to ensure payment to the group practice by Medicaid.
July 10, 2007 Update
Revised NPI Application/Update Form
The NPI Application/Update Form (CMS-10114, 05-07) has been revised and is now available for download on the CMS website... More information on the revisions to the form, as well as a link to the revised form, is available at
http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Announcement_for_Revised_NPI_Application_form.pdf on the CMS NPI website.
The Importance of Up-to-Date Billing Software
Providers that use billing software should make sure they are using the most current version. Software vendors have made changes to accommodate the NPI. Running an outdated software version could contribute to claim rejections or the inability to send your NPI.
National Uniform Billing Committee (NUBC) Response Regarding Printing Problems with the UB-04 Form
It has come to the attention of the NUBC that some laser printers are having difficulty meeting the print specification of the UB-04 form. The UB-04 form and the UB-92 contain identical margin specifications. Both forms are 82 characters across. To accommodate the 80 character limitation of some laser printers, many users of the UB-92 form developed workarounds that basically “cheated” on the printing layout. This was commonly accomplished by starting in the second position and ending in the 80th position, basically ignoring the first column on the left and the last column on the right. The UB-92 had no critical data elements in these fields. In order to meet the UB-04 print specifications, users should utilize laser printers that have “edge-to-edge” print capability (4 mm margins on the left and right) or wide carriage impact printers (dot-matrix or line printers). More information can be found at http://www.nubc.org/UB-04_Printing_Requirements.pdf on the NUBC website.