| Click a question below to learn more about NPI. |
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| 1. Where do I go to get set up for NPI? |
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Use the web-based process set up by the National Plan and Provider Enumeration System (NPPES). This process was available beginning May 23, 2005. Click Here to start the application process.
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| 2. Are you currently accepting NPI on claims? |
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| Yes, but the claims must also include legacy identifiers. We are following the Centers for Medicare and Medicaid Services (CMS) timeline which established October 1, 2006, to May 22, 2007, as a dual path transition period. MedAvant began accepting NPI on August 1, 2006, for ANSI 4010 A1 claims, however, legacy identifiers must be in the applicable ref segments. Until payers begin accepting NPI, MedAvant will only forward the legacy identifiers. Our Phoenix SM claims processing system can configure at a payer level to allow the NPI in outbound payer files. We will activate this option based on the timeline of each payer. As payers begin accepting NPI, we will forward both the NPI and legacy identifiers for claims submitted in the ANSI 4010 A1 format.
For non-ANSI formats, please consult the NPI companion guides. Click Here.
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| 3. Will you be able to receive both the old provider license numbers and the new NPI numbers? This is referred to as dual billing or dual path submission approach. |
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Yes, MedAvant is implementing the dual path submission approach being adopted by CMS. See the answer to question two.
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| 4. We are currently transmitting to MedAvant using 4010A1 837. Can you tell me where we will need to make adjustments for NPI? |
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ANSI 4010 A1 submitters must follow the following guidelines when sending claims with dual identifiers:
The NPI must appear in the NM109 and the corresponding “XX” qualifier in the NM108 element of the applicable loops. Claims must also contain the provider legacy ID number and provider tax ID/SSN as ref segments in the applicable loops. Due to the CMS guidelines on submitting NPI during the transition period, MedAvant cannot accept claims that contain only NPI. Examples of claims meeting these criteria are available by Clicking Here.
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| 5. We currently transmit our file in the NSF format, and I need to know the following: |
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| What record and field in the NSF form do I need to record the NPI? |
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MedAvant’s NSF companion guides for submitting NPI in the claim are on www.medavanthealth.com. Click Here then scroll down to NPI and choose the format you need.
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| When will we be able to submit claims in the NSF format that contain the NPI? |
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If you are submitting NSF 4.0, MedAvant is accepting NPI.
MedAvant will begin accepting NPI on NSF 3.01 claims early in 2007.
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| 6. We currently send claims to MedAvant in the print image format. How do we add NPI on our print image claims? |
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CMS has approved a new CMS-1500 claim form which contains additional fields for NPI. MedAvant will be ready to accpet this new claim format early in 2007. Once the new form is accepted by payers, we will also accept the new form including those with NPI identifiers. A sample of the new form is available by Clicking Here.
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| 7. MedAvant currently processes my paper claims. Will your system print the new CMS claim form developed for NPI? |
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Yes, we will convert to the new form once payers accept the form.
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| 8. I do not currently have a support contract with my software vendor so I will not be able to send NPI in my claims. What are my options? |
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As a clearinghouse, MedAvant provides ANSI translation services for clients who submit non-standard formats. We recognize that many of these clients may not be able to submit both the legacy identifiers and NPI in their claims. To assist these clients, we are developing enhanced versions of the non-standard formats for those submitters who wish to participate in the transition period.
Please reference the applicable companion guide for instructions.
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| 9. Will MedAvant validate NPI data in the claims? |
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MedAvant will add a “check digit” edit on all claims containing NPI. If the edit determines the format of the submitted NPI is in error, the claim will reject. It is currently too early to know if payers are going to require a validation edit on NPI. MedAvant will comply with the edit requirements established by the payers.
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10. Should I send claims with NPI data during the
transition period? |
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MedAvant cannot make this decision for you, however, we urge all providers to obtain their NPI now. It is important that everyone understands that during the transition period, most payers will begin accepting NPI, but will still require the parallel submission of their legacy identifiers. Claims prior to May 23, 2007, will be processed off of the legacy identifiers; not NPI. In addition, if you send an invalid NPI, your claims will reject at the payer and can result in a payment disruption.
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11. When we receive all of the NPI’s for our physicians,
how do you want to receive them? |
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Customers who use MedAvant’s portal can add their NPI to their profile on the enrollment tool.
For sites that are already on the system, go to Manage Sites, choose Update Site, choose to edit your selected site, add the NPI, then click Update Site Information.
For individual providers that are already on the system, go to Manage Providers, choose Edit Provider NPI, select the provider, add the NPI, then save changes.
Customers who do not use the portal can fax the NPI documentation from NPPES to 404-877-3324.
If you do not use the portal and have more than 10 providers in your office, Click Here for a spreadsheet to use. Send the completed spreadsheet to MedAvant’s enrollment department at Provider.enrollment@medavanthealth.com or FAX 404-877-3324.
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| 12. Will MedAvant reject claims for not using NPI after 5/23/07? |
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No; at least not globally. The decision to reject claims for not using NPI will be based on each payer’s requirements. Small health plans have an extended compliance date of 5/23/08; and, atypical providers do not meet the criteria for NPI enumeration. Therefore, a global edit would be inappropriate.
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13. Will parsing of reports be impacted if the payer does
or does not return the NPI in their acknowledgements or
other proprietary reports? |
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If the payer returns our claim identification number ( Loop 2300, REF*D9) in claim responses today, whether or not NPI is returned should be of no consequence. If the payer does NOT return the claim identification number, then the payer must submit its specifications to ensure seamless implementation.
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| 14. Will MedAvant require testing? |
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No, MedAvant will not require testing. If payers require testing, MedAvant will begin scheduling required tests in first quarter of 2007; however, payers should let us know their requirements and implementation plans as soon as they have been confirmed.
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15. Do you plan on validating whether the NPI being
submitted belongs to the provider submitting it? |
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There is no plan at this time to validate NPI beyond the check digit rules published within the final rule which can be found on Implementation Central under NPI check digit.
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| 16. What if I still have questions concerning transition to NPI? |
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Payers, please send your questions to MedAvantNPI@medavanthealth.com
Providers, please send your questions to techsupport@medavanthealth.com
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