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NPI Enumerator
The
Administrative Simplification provisions of the Health
Insurance Portability and Accountability Act (HIPAA)
mandate that all health care providers conducting
standard electronic transactions apply for and use a
unique standard identifier called the National Provider
Identifier (NPI) effective May 23, 2007. The NPI is
also being adopted for use on the revised 1500, UB-04,
and American Dental Association (ADA) billing forms.
In
early 2005 the Centers for Medicare and Medicaid
Services (CMS) awarded the NPI Enumerator contract to
FOX Systems, Inc. In this role, FOX processes provider
NPI applications, issues new NPI’s and operates the call
center. FOX’s reputation as a national leader in HIPAA
IT consulting and solutions, and ability to integrate
detailed knowledge of NPI regulations, healthcare
systems and business processes, and Enumerator
operations is now available to your organization to
assist in NPI compliance efforts.
The NPI Challenge to Healthcare Organizations
– Compliance with NPI requirements will greatly
challenge all healthcare organizations – health plans,
providers and clearinghouses – and their HIPAA business
associates and trading partners who must also coordinate
compliance with all HIPAA requirements. In the initial
industry analyses the impact was thought to be limited
and efforts focused on the mechanical aspects of
capturing and using a new provider identifier within
legacy business processes and systems. Organizations
concentrated on the need to develop clean “many to one”
mappings between new provider NPI’s and legacy provider
IDs.
More
thoughtful discussions concerning impact have now
concluded that NPI may affect healthcare organizations
as much as the original wave of HIPAA EDI transaction
and code set implementations or Y2K. As noted in FOX’s
NPI Whitepaper available under “NPI Resources”, there
are severe consequences to not being able to meet the
NPI compliance deadline as well as risk considerations
related to compliance activities. Delayed compliance or
non-compliance may result in payment disruptions for
providers. Non-compliance may also create problems in
many different business areas including budgeting,
forecasting, reporting, claims processing, status, and
remittance reporting, eligibility, provider enrollment
and credentialing, contracting, authorizations and
referrals. NPI will impact many systems, business
processes, and policies and procedures and may disrupt
mission-critical functions unless addressed in a timely
and comprehensive manner.
By
now, organizations should be well on the path to NPI
compliance and should have started the process of
assessing the impact of NPI on their operations and
systems. In fact, it has been recommended that testing
must begin February 2006 in order to have sufficient
time for implementation.
FOX Approach
– We have developed robust methodologies and tools to
assess NPI impact on systems and business processes,
plan for NPI remediation, and provide remediation
services. These have been tailored to the specific needs
of health plans and providers and are scalable solutions
for organizations of all sizes. Our expert consultants
are equipped with detailed and comprehensive Practice
Guides which lay out the approach, tasks and methods for
NPI compliance. Coupled with our strong internal
practices linked to our ISO 9000, staff PMP and other
certifications, FOX and our staff can ensure that your
NPI compliance project will be successful.
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