HIPAA has mandated the adoption of National Provider Identifier (NPI) numbers with the goal of improving the efficiency of electronic claims. “In the past, providers have had to use a different ID with each carrier when filing claims,” said Nancy Ellis of MediSYS. “With the NPI, they will have one number that works everywhere.” However, some Alabama providers are encountering a number of difficulties with the transition. “We had time to test the systems with most of the insurers and with Medicare,” said Donna Burns of Physician’s Resource Network. “But Medicaid of Alabama’s new NPI web site went live just before we started using it. We’re helping our clients work through issues, but it has been difficult for medical offices who are trying to deal with it alone. “In fact, so many claims were rejected that Medicaid has been offering a contingency plan, paying 70 percent of the amount a practice usually receives. It’s only available on request, and would need to be posted in a suspension account until it can be credited to individual claims when they are approved. This could increase the staff work load, so we suggest avoiding this option unless it is necessary for cash flow.” Rhonda Boatwright of MediSYS, added, “This has been particularly hard for pediatric practices and others that have a large percentage of claims filed through Medicaid. Some physicians in small practices who try to manage their own billing didn’t realize there was a problem until they saw their account balance.” How did this situation develop? Burns said a significant part of the difficulty stems from the fact that “unlike most fields, where software drives change, in healthcare change drives software, and it’s a constant race to keep up with mandates, rules and other new developments. That makes it essential to stay informed.” For office staffs, part of the difficulty in implementing NPI was that different carriers switched to NPI identifiers at different times and required NPI submissions in different formats. Federal regulations require all providers and carriers to be using NPI numbers by May 23. “The hardest part has been getting the numbers to the carriers. There has not been a uniform way to send them,” said Judy Campodonico of Management Resource Group. “We had to re-fax one to Medicaid four times, and the number still wasn’t showing up. I called and waited on hold for 40 minutes.” Denise Gilley of Physicians Resource Network, had a similar experience. “I called about a trading partner ID, and they were so swamped by calls, I was transferred to Florida,” she said. Missing trading partner IDs were the source of problems for some. “Medicaid sent providers what they called the green letter and the blue letter,” Ellis said. “The green letter went out February 8 telling how to get a password. That had to be acted on immediately. The blue letter was only sent to providers who filled out and returned a trading partner form last year. If the form was mislaid or not returned, they didn’t receive a blue letter. There was no way to transmit until they had a blue letter in hand, so some people were in an urgent situation trying to get one before the checkwrite date on March 7th.” Other opportunities for misunderstandings complicated the transition. “When some of our solo clients got their NPI number, they thought they didn’t need a group number because they weren’t a group. We had to explain it was linked with their tax ID,” Campodonico said. Ellis added, “That name is somewhat misleading. Solo practices might think they didn’t need it. But if they don’t have it, they won’t get paid.” Julie Mobley of Physicians Resource Network pointed out that the group number also acts as a location identifier. “If you see patients at more than one location, you need to make sure you are using the right group number for that location, or the claim could be rejected.” For referred patients, it’s important to make sure the correct NPI and group number from the referring physician is on the claim, in order to be paid. Practices should also make sure carriers have correctly linked their NPI numbers to other identification. “The NPI should be linked to the legacy number, group number, UPIN (Unique Provider Identification Number) and Tax ID. If not, claims will be rejected,” Ellis said. “Errors can occur on the carrier level. You need to go to each carrier’s Web site or call their 800 number to confirm that this information is properly linked. In some cases, the links are only updated once a week.” After a claim is submitted, it is important to verify that it went through correctly. “You need to look at the claim status report immediately, Boatwright said. “In the past you could simply check the audit trail. Now with Medicaid, you must go online to find a rejection code and fix problems before checkwrite day.” Gilley explained, “The way Medicaid’s Web site works is different. You have to sign in with a password to use it, then log into another area to see whether the claim went through correctly. Reports are in a different format now. It isn’t easy to look at them and understand what you’re seeing.” So how are the professional billing firms coping with NPI? “We knew it was coming, so we were diligent in preparing for it,” said Campodonico. “For most of our clients it has been smooth sailing, but the transition took a lot of work, time and persistence.” “You have to stay on top of change,” Ellis said. “You have to be proactive in learning about changes and have someone who will go out and get the information. You need to check what you are doing every step of the way.” May 2008