WASHINGTON--After months of preparation, the eagerly awaited Internet registry of National Provider Identification numbers and other health care provider data is operational.
The system allows health care providers to locate their referral sources' NPI numbers and other critical data in order to submit compliant claims to Medicare. It was established by CMS as a means of complying with provisions in the Health Insurance Portability and Accountability Act.
The registry should be a help to both providers and HHS, CMS said in a notice published in the May 30 Federal Register. "Internet availability eliminates the need for entities to submit initial and ongoing requests for data to HHS and for HHS to process and respond to each of those requests," the notice said.
The data, which discloses only information obtainable through the Freedom of Information Act, is available in downloadable files and in a query-only database. Users can query by NPI or provider name to access the information, and data will be updated monthly. There is no charge to access the registry, and no user IDs or passwords are required.
"It is still good for providers to try and obtain the information from the physicians at the time of referral, but if that is not a possibility or the intake person has forgotten, the registry is a great tool," said Sarah Hanna, vice president of ECS Billing & Consulting in Tiffin, Ohio. "Our medical documentation department is using it and finding it to be helpful."
With the registry operational, it is critical that providers include NPI numbers on their claims, officials said. "Between the period of Sept. 3, 2007, and Oct. 29, 2007... Part B carriers and DME MACS will begin to turn on edits to validate the NPI/[legacy number] pairs submitted on claims. If the pair is not found on the Medicare NPI crosswalk, the claim will reject," CMS said in a communication to providers.
The agency also stressed the importance of validating that the National Plan and Provider Enumeration System has all NPI and legacy numbers a provider intends to use on claims. "If the information is different in the two systems, there is a very good chance your claim will reject," CMS said.
CMS said Medicare contractors might contact providers that have not been submitting their NPIs or those with a high volume of rejections in order to validate NPPES information.
The registry.
A Medlearn Matters article on using the NPI correctly on Part A and Part B claims.
For information on using the NPI on the new CMS 1500 and UB-04 forms.
