LTC 205 NPI Special Bulletin FINAL - TMHP

1 Copyright AcknowledgmentsUse of the American Medical Association s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication with the following disclosure: Current Procedural Terminology (CPT) is copyright 2007 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regulation System/Department of Defense Regulation System (FARS/DFARS) restrictions apply to government use. The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: CDT4/2007 [including procedure codes, definitions (descriptions), and other data] is copyrighted by the American Dental Association.

2 (c) 2006 American Dental Association. All Rights Reserved. Applicable Federal Acquisition Regulation System/Department of Defense Acquisition Regulation System (FARS/DFARS) restrictions apply. Special BULLETINNATIONAL PROVIDER IDENTIFIER (NPI)for Long Term Care (LTC) ProvidersThis Special Bulletin is intended to notify Long Term Care providers of program changes related to the National Provider Identifier (NPI) implementation and the recently announced Contingency Period beginning May 21, TERM CARE Special Bulletin NO. 205 JUNE 2007 INSIDELong Term Care Providers 1 NPI Implementation Overview 1 NPI Contingency Period Announced 2 Atypical Provider Identifiers 3 Announcing TexMedConnect 5 Updated tmhp EDI Companion Guides 6 Vendor Testing Begins June 2007 6 New DADS Form 1290 6 NPI Information and Help 6 LTC Crosswalk Solution Developed for Claims Processing 7 Forms 8 DADS 1290 Claim Form 8 Quick Reference Guide 9 NPI Implementation OverviewThe Health Insurance Portability and Accountability Act (HIPAA)

3 Of 1996 established the NPI as the standard unique identifier for health care providers and requires covered health care providers, clearinghouses, and health plans to use this identifier in HIPAA-covered transac-tions by May 23, 2007. On April 2, 2007, the Centers for Medicare & Medicaid Services (CMS) announced that it will allow contingency plans, not to extend beyond May 23, 2008, for entities that will not meet the May 23, 2007, deadline but who have demonstrated a good faith effort to meet the compliance date. As a result, NPI implementation will occur in phases for LTC providers. The intent of this Special Bulletin is to provide information regarding these different imple-mentation dates and phases, and to detail the actions providers need to take to ensure a smooth transition to NPI.

4 Providers should ensure their billing agency (vendor) is aware of and complies with the NPI require-ments outlined in this Bulletin . It is ultimately the provider s responsibility to ensure claims are submitted in accordance with all guidelines. NPIC ontingencyPeriod Announced!See page 2In order to avoid billing delays, LTC providers should have obtained their NPI or API (see page 3), and have reported their NPI to DADS by June 1, 2007. CPT only copyright 2007 American Medical Association. All rights Term Care Special Bulletin , No. 2052 National Provider Identifier Special BulletinLong Term Care ProvidersNPI Contingency Period AnnouncedDue to the CMS announcement on April 2, 2007 (see previous article), the Texas Health and Human Services Commission (HHSC) and tmhp have developed a phased approach to NPI implementation.

5 Each phase is described in detail below. Phase One Began May 21, 2007 This first phase of the Contingency Period, called Enhanced Dual Strategy, began on May 21, 2007, and allows providers to submit an NPI in addition to a Contract Number on electronic transactions. Participation in Enhanced Dual Strategy is optional; providers may continue to submit claims with only the Contract Number. However, all providers are encouraged to submit an NPI when submitters, including third party billers, partic-ipating in the Enhanced Dual Strategy will notice the following changes: Claim transactions 837I/P/D include both the NPI (optional) and Billing Referral Number (optional) in addition to the Contract Number (required).

6 Electronic Remittance & Status (ER&S) reports have been modified to include the NPI, Billing Referral Number, and Contract Number. To receive the Enhanced Dual Strategy version of the ER&S report, providers must contact the EDI Help Desk (1-800-863-3638).Eligibility verification requests include both NPI (optional) and Contract Number (required). However, the eligibility response has been modified to include the NPI, Billing Referral Number, and Contract Number. Both the NPI and Billing Referral Number are new to the response transaction, and a submitter that sends the NPI on the request must be prepared to accept the NPI and Billing Referral Number on the the Contingency Period, TDHconnect users may submit electronic transactions (837 and 270) with an NPI number in addition to the Contract Number.

7 However, TDHconnect ER&S reports will not contain an ClaimsDuring the Enhanced Dual Strategy phase, providers must continue submitting a Contract Number on all paper claims; an NPI is optional. The table below identifies NPI implementation milestones, including dates supporting Enhanced Dual Strategy:DateMilestoneDecember 2006 NPI webpage released on the tmhp website at 1, 2006 NPI submission to DADS 1, 2007 tmhp accepts both the current Form 1290 and the NPI-supported Form 1290 (see article on page 6) with current Contract 2007 Enhanced Dual Strategy EDI companion guides available at 14, 2007 NPI compliance EDI companion guides 21, 2007 TDHconnect transactions 837 and 270 may continue to be submitted with an NPI in addition to the Contract.

8 TDHconnect ER&S reports will not contain an NPI. Electronic EDI transactions 837, 835, 270, and 271, and claim submissions available with NPI, Contract Number, and Billing Referral Number (Enhanced Dual Strategy). This does not include transactions submitted using questions, call the tmhp Call Center/Help Desk at only copyright 2007 American Medical Association. All rights Provider Identifiers Providers who do not offer healthcare services are not required to apply for an NPI, but must notify DADS that they are an atypical provider. All contract numbers must be listed on the DADS Contract NPI/API Association form (see Reporting your NPI to DADS, on the following page).

9 DADS will assign a ten character atypical provider identifier for each of the contracts listed. For each contract, the API will be the letter D and the 9 digit contract number ( , D000001234). Beginning with NPI implemen-tation, claims submitted by atypical providers must include an : Only the NPI can be entered into TDHconnect. An API will not be accepted until TexMedConnect is implemented in November 2007 (see article on page 5). Long Term Care Special Bulletin , No. 2053 National Provider Identifier Special BulletinLong Term Care ProvidersPhase Two Begins July 30, 2007 The second phase of the Contingency Period begins on July 30, 2007, and allows EDI submitters to submit electronic transactions in the following ways:NPI-Only Contract Number-Only Both NPI and Contract Number (dual strategy) Note: The date when the Contingency Period ends and NPI-only compliance begins has not yet been determined.

10 Monitor future provider notifications for the exact date of full NPI implementation. R&S Reports Beginning with paper R&S reports dated August 3, 2007, tmhp will include a Contract Number, NPI, and Billing Referral Number for those providers who have supplied DADS with their NPI Reports EDI providers who wish to receive NPI and related data beginning with ER&S reports dated August 3, 2007, must contact the EDI Help Desk and have reported their NPI to DADS. Providers may elect to receive NPI data on ER&S (835) responses in one of two ways:NPI and Contract Number. Providers may call the EDI Help Desk to receive the ER&S in a dual format.