It is time once again to revisit our old friend “NPI”,
and while right now, it is probably hard to believe, we all need
to remember that the reason we are all going through this immense
trouble is for the purpose of “administrative simplification”.
It may not seem like it right now, but life after full NPI compliance
is going to be easier.
We will soon be able to find out how true this is, as we move towards
a very soon full NPI compliance date. CMS has recently handed down
2 very important dates, which all Medicare and Medicaid intermediaries
are supposed to follow.
The first date, March 1st, 2008, has already passed. As of March
1st, all claims you submit to any Medicare and/or Medicaid Carrier
MUST contain an NPI number, thus ending the period they referred
to as “dual acceptance”. They will no longer accept claims
with JUST the legacy ID number as of this date. Hopefully, all of
you have already transitioned to the new NPI number, which we made
available for free to our clients as of our October, 2006 newsletter.
The second date is fast approaching. As of May 23rd, 2008, Medicare
and Medicaid intermediaries will begin to REJECT all claims that
contain any legacy ID numbers, including Medicare and Medicaid PIN
numbers, UPIN numbers, state licenses, facility ID numbers and the
like. Most intermediaries are heavily pushing submitters to stop
sending legacy ID numbers now, with some intermediaries displaying “informational” error
messages on their response reports when you send claims with a legacy
ID. As of May 23rd, 2008, these errors will turn from “informational” to “reject” error
messages.
Experience tells us that we do not want to be waiting until the last
minute (May, 22nd, for example) to stop sending legacy ID numbers.
In addition, experience has also taught us that, despite what EDI
representatives are trained to say, we also do not necessarily want
to be the first submitters on the block to stop sending legacy ID
numbers. Clients who believed these EDI representatives, and removed
their legacy ID numbers have unfortunately learned firsthand why
you want OTHERS to be Medicare’s guinea pigs.
To make this transition as seamless as possible for our clients,
we have decided to take a programmatic approach to these two important
dates. We have officially released Validator 5.13 specifically to
handle this transition. Those who download and install this update
will find that there are 2 new fields when they click on Settings
| Carrier Setup Options on a new tab labeled “NPI”. These
are:
1. The date this carrier requires the use of the NPI – This
will activate error checks on over a dozen “NM108” and “NM109” fields
to check to see if you are sending an NPI number BEFORE the claims
get sent to the carrier. The recommended default for this date is
3/1/08.
2. The date this carrier requires ONLY the NPI – This will
activate within the Validator program a routine which will REMOVE
legacy ID numbers from your claim. The recommended default for this
date for all Medicare and Medicaid intermediaries is NO LATER than
5/23/08.
It is important to note that with this update you SHOULD NOT manually
remove your legacy ID’s from Lytec or AltaPoint. In fact, you
need not make ANY changes in Lytec or AltaPoint to be compliant for
your electronic claims. Your paper forms, however, should be modified
manually to accommodate those payers who are still on paper.
Once you have applied the update, you will want to make sure you
will not have problems with NPI full compliance. To do so, simply
go to Settings | Carrier Setup Options and click on the NPI tab.
From there, you want the first date to be 3/1/08, and the second
to be yesterday’s date. Then all you need to do is run a small
batch of claims through the Validator. If you are missing an NPI,
Validator will popup an error message, and you will know where you
need more NPI numbers entered in. Once the claims have been processed
through the Validator, send them to your carrier. If the claims go
through and your provider gets paid, you need not do anything. If
they reject, it is likely your carrier is not ready for full NPI
compliance yet, and you can always change the second date field back
to a future date, or blank it out. We feel this is much easier than
removing all legacy ID numbers, then trying to make sure you put
them all back in the same places when you find out your carrier is
not ready.
Validator 5.13 now supports paperwork
In response to the federal electronic commerce initiative, Physician's
Software Solutions, Inc. has added some new capabilities to your
Validator program.
The initiative is designed to increase the number of claims that CAN be
sent electronically, especially in the case of workers compensation
claims. These
claims traditionally needed to be sent via paper because of the large volume
of paperwork required in order to get the claim paid. While technology
has not advanced to the point where you could scan your paperwork
into the Validator,
we have come up with a workable solution, which should reduce your offices’ postage
costs, administrative costs, and reduce the time it takes to get paid for
your claims.
How it works:
The claims you send can now contain a segment called a “PWK” segment
(paperwork). This segment, when run through the Validator, will automatically
be branded with a unique “attachment control number” which is your
submitter ID followed by the batch ID number of the claim file. When processing
is complete, Validator will automatically print out a Fax cover page for you
with the attachment control number on it.
What to do:
If you have a carrier who usually asks for paperwork, ask them if they support
the “attachment control number” via fax method instead. If they
do, contact your Validator representative for a quick customization to your
form files which will activate the PWK segment. Then start sending!
