Industry Notes:
NPI SNAGS CONTINUE TO PLAGUE PROVIDERS
Published on Mon May 14, 2007
Double-check your NPPES information to avoid hold-ups.
As the first month of National Provider Identifiers comes to a close, the new numbers are still giving providers fits.
"We continue to identify providers submitting claims to Cahaba GBA without a valid NPI number," the regional home health intermediary says in a message to providers.
The problem: Providers either haven't applied for their NPI or the data in their National Plan and Provider Enumeration System (NPPES) NPI file does not match that data in their Fiscal Intermediary Shared System (FISS) file, Cahaba explains.
The solution: If you haven't yet applied for your NPI, do so right now. And it's just as important to check your NPPES file to make sure it's accurate, Cahaba urges. "We strongly recommend that all providers, regardless of whether a problem has been identified, access the NPPES site to verify the information submitted is complete and accurate," the intermediary says.
But if it's your referring physician's information that's incorrect, things may get trickier. Right now, claims must have the referring physician's legacy number (UPIN) to process, Cahaba says. That means you can submit a claim with both the NPI and the UPIN, or just the UPIN alone, the RHHI details.
Do this: If you have claims returned to provider (RTP'd) for reason code 19201, make sure they contain an NPI and UPIN and then resubmit them, Cahaba advises.
Intermediary Palmetto GBA says problems its providers were experiencing with NPI edits have been resolved and claims are processing normally. The RHHI had advised providers to quit using NPIs as a temporary work-around, but now providers should include NPIs on all claims, Palmetto directs on its Web site.
Claims RTP'd due to 19201 "are being moved to location SMNNPI and manually RTP'd for correction of the UPIN, NPI, or physician name," Palmetto says. "All claims should be submitted with the appropriate NPI and UPIN."
Look it up: Meanwhile, home health agencies are eagerly awaiting the unveiling of the NPI directory at the end of this month (see Eli's HCW, Vol. XVI, No. 20). "Since home health agencies are required to have the referring physician's NPI on claims, access to this database is imperative," the National Association for Home Care & Hospice notes.
At first, the Centers for Medicare & Medicaid Services will make the directory available as a download and also in a query-only format, NAHC notes. "The downloadable file will be discontinued if, after some time, the query-only file serves providers' needs," the trade group says. • Federal lawmakers continue to look for ways to fund the State Children's Health Insurance Program, and that leaves home care providers vulnerable. The Senate Finance Committee plans to address SCHIP legislation soon, although full Senate action on the issue isn't expected until [...]
