Endocrine Insider
March 21, 2007

NPI-Sharing Policy Still Unclear
As of May 23, 2007, all claims submitted to CMS and private payers must contain your National Provider Identifier (NPI) number. Your “legacy identifiers,” such as Medicare Provider Identification Number (PIN), Unique Provider Identification Number (UPIN), and proprietary commercial identifiers, will no longer be accepted on claims submitted after this date. The Health Insurance Portability and Accountability Act (HIPAA) mandates that physicians submitting claims electronically use the NPI. Going one step further, CMS has made the decision that all claims, whether submitted electronically or via paper, must contain the NPI after May 23. Physicians submitting paper claims must begin using the modified CMS 1500 paper form, which contains space for reporting the NPI number, by June 1, 2007. CMS has instructed carriers to reject any claim that is missing the NPI after May 23 and return it to the physician.

In order to receive payment for many services, physicians will be required also to include the NPI of the patient’s referring physician on the claim form. At issue is how those identifiers will be communicated between physicians. CMS plans to develop an NPI database that will allow physicians to search for the NPI of other physicians, but the availability date of such a site remains in question. In the meantime, physicians are encouraged to request the NPI from any physicians that typically refer patients to their practice. Because CMS is not likely to have established a process for sharing NPIs by May 23, the National Committee on Vital and Health Statistics (NCVHS) is encouraging the agency to continue using the PIN/UPIN in addition to the newly required NPI beyond the May 23 implementation date. CMS is aware of the need to release the NPI-sharing policy but was unable to provide a timeline for when the policy will be available to physicians.

For detailed information on the topic of NPI requirements, you may view CMS’ transmittal here: http://www.cms.hhs.gov/Transmittals/downloads/R1187CP.pdf. Information will be reported in Endocrine Insider as it becomes available.