NPI Madness
If there is one thing in the medical billing
industry that will always remain the same, it is change! That being
said, not everyone is going
to believe me when I say that this change (eventually) is going to
be a good thing! The new “National Provider Identifier”,
a part of the original HIPAA legislation, is about to take effect.
The overall premise of the NPI number is that it is to replace the
existing ID numbers you are currently using to identify your providers,
groups, and facilities, (yes, just like the UPIN was supposed to,
but for real this time, I promise!). This is great progress towards “administrative
simplification” because instead of having a Blue Shield Pin
for Blue Shield claims, an Aetna PIN for Aetna claims, a Medicare
PIN for Medicare claims, and any number of other unique IDs, you
will only have to send the NPI number, and all insurance payers MUST
accept this number as a means to identify your providers, facilities,
and groups practices.
This sounds great! So what is the problem then?
There
are two problems associated with this process:
1. For a limited time, you are expected to send BOTH the new
NPI number as well as the existing PIN numbers to all of your
payers.
This will allow them to properly prepare for the transition to
an “only
NPI” world!
2. You may have noticed that your Lytec program does not have an
NPI field.
Oh Great, so there is another compulsory upgrade!!!
The
short answer is, no! While Lytec 2006 has some great new features,
and if you have Lytec XE or older, there are some
serious financial
incentives to upgrade to Lytec 2006 BEFORE September 29th, you
DO NOT HAVE to get a Lytec upgrade in order to comply with this
new requirement. We are well aware that this contradicts what
Lytec themselves are telling you in their recently mailed
postcards.
What Lytec is telling you is that you MUST upgrade to the 2006
version to be compliant, but this is ONLY true if you use THEIR
clearinghouse. Lytec has, since the old DOS based 6.5 versions,
always had “custom fields” which allow you to add
additional information about your providers. Just because there
is not a field
with the letters “NPI” next to it does not mean you
cannot send one.
So what do I need to do first?
For
starters, you need to GET an NPI number. You can apply for one
on line at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.
Once you have your NPI number, you will need to put it into your
Lytec program. If you have Lytec XE, 2004, or 2005, we highly
suggest
using the “Other ID” field, which is on the “Other
IDs” tab under Lists\Providers. If you have an earlier
version, we strongly suggest you consider getting Lytec 2006
before September
29th to take advantage of a 25% savings offer Lytec is currently
running (which is a significant discount!!!). If you choose to
stay with your existing system, you may of course use a custom
field to store your NPI Number.
How do I get this NPI number on my claims?
For our valued Validator users, we will be releasing Validator
version 5.11 very shortly, another free update to help you
stay abreast
of the constant changes that come your way. The forms that accompany
Validator version 5.11 will include the ability to pull the NPI
number from Lytec XE, 2004, 2005, and 2006 from the “Other
ID” field mentioned above. For those of you using an older
version of Lytec, and thus do not have the “Other ID” field,
you will want to contact our offices to have your existing Validator
electronic claims forms modified to accommodate this field at our
normal support rates.
What about my paper claims, and this new HCFA 1500 form?
As
a courtesy to any Stephens & Associates clients, we will be providing
a template for the new HCFA 1500 paper format which includes the
NPI number
(pulled
from the other ID field mentioned above).
This template is provided as-is, so if you have
made some
modifications to your HCFA forms, they may differ from the one
we offer here. We are more than happy to help you modify these
formats to fit your specific needs at our normal support rates.
Of Course, if you have any questions about this new NPI requirement,
or of Validator or Lytec implementation of the new NPI, we are more
than happy to help address any of the concerns you may have!
