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!
