(1) Are your new Billing and Companion Guides available?
A: Updated billing and companion guides are available by clicking below to access appropriate provider handbooks, billing guides and companion guides for all provider types:
- Billing Guides
- Companion Guides
(2) Are you using our inbound NPI data to populate your system?
A: No.
(3) If no, how do you plan on populating NPIs into your system?
A: Providers will need to register their NPI information with the Department of Human Services with confirmations from the CMS enumerator. (See enrollment FAQs for details)
(4) When will the Department of Human Services begin adjudication of claims based on the NPI?
A:The NPI will be required on the submission of all Health Insurance Portability and Accountability Act (HIPAA) regulated transactions no later than May 23, 2008. Information on the NPI Contingency Plan is contained in theNPI Contingency Planpresentation.
(5) Are providers required to submit their 13-digit PROMISe Provider ID number and an NPI for a transition period?
A: Providers are not required to submit both identifiers but are permitted to do so under theNPI Contingency Plan
(6) Will the Department of Human Services require Taxonomy Codes on the claim form?
A: We will be using the NPI number, the taxonomy, and the five- or nine-digit zip code whenever possible to make an accurate one-to-one connection from the NPI number to the existing 13-digit PROMISe Provider ID and are therefore requesting that taxonomy codes be provided whenever possible.
(7) Will the 835 (Electronic Remittance Advice) contain the NPI that is sent to the Department of Human Services on an incoming claim?
A: If the NPI is sent in on the incoming transaction and registered with the Department of Human Services, then it will appear on the 835.
(8) Will you strictly use the NPI, or 13-digit PROMISe Provider ID number, via "back end mapping" to determine how to pay claims and to whom?
A: We will be using a crosswalk system to connect the NPI to the existing PROMISe Provider ID numbers. Claims processing will continue to use the PROMISe ID numbers to complete internal processes. The PROMISe Provider ID number will then be crosswalked or connected back to the NPI number for outgoing communication.
(9) Will different fields be used on claims to determine how to pay claims (i.e., location, group, taxonomy, bill type etc.)? If so, what fields/data elements will you use?
A: A combination of, NPI, taxonomy and zip code will be used to determine a one-to-one match with the provider's current 13-digit PROMISe Provider ID. Once the NPI, taxonomy and zip code is connected to the PROMISe ID the claim is processed as it is today.
(10) Which fields will be used for those NPIs? Will taxonomies be required on claims?
A: Please click below to access the appropriate provider handbooks, companion guides and billing guides for all provider types.
- Billing Guides
- Companion Guides
(11) Currently, some forms require license number (Prior authorizations, Program exceptions). Will it remain that way? How are Durable Medical Equipment (DME) handled?
A: The NPI will replace the license number in the 837 transaction. DMEs are not atypical and will be required to obtain an NPI if they conduct HIPAA covered electronic transactions. Please click below to access the appropriate provider handbooks, billing guides and companion guides for all provider types.
- Billing Guides
- Companion Guides
(12) Will NPI take the place of license number?
A: NPI will take the place of license number on the 837 electronic transactions
(13) Will the Department of Human Services still be using the PROMISe Provider ID number and the new NPI's used to identify providers and sub-parts?
A: Department of Human Services will be using the NPI, taxonomy, five- or nine-digit zip code that is submitted on the 837 electronic transaction which is then crosswalk or connected to the PROMISe Provider's ID. Once the PROMISe Provider ID number is found, the claim will be processed as it is currently processed today.
(14) Which fields on the claim submission will be used for NPIs?
A: Please click below to access the appropriate provider handbooks and billing guides for all provider types.
(15) Will the referring and billing provider NPIs be required?
A: Yes. Please click below to access the appropriate provider handbooks and billing guides for all provider types.
(16) Do you allow testing for NPI?
A: Although the formal testing period has ended, the implementation of the NPI Contingency Plan provides an opportunity for providers to conduct testing. Beginning June 1, 2007 providers who submit a legacy number (13-digit PROMISe Provider ID) and an NPI number on claims will be able to conduct their own tests. Submitting both a legacy number (13-digit PROMISe Provider ID) and an NPI number on claims will allow providers to verify that the NPI number they are using matches the legacy number as intended.
(17) Will the paper remittance advice (RA) contain the NPI number?
A: An NPI number will display on both the paper and electronic RAs if one is submitted on the claim.
(18) How are payments being handled for claims with new NPI numbers?
A: Payments will be handled as they are being handled today. The crosswalk will allow the existing internal processing to continue to make use of PROMISe Provider ID numbers and therefore continue to process claims as they are processed today.
