Minnesota HIPAA Collaborative

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Minnesota HIPAA Collaborative

• NPI Exchange
• A Providers Perspective
• Laurie Darst
• Mayo Clinic

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Exchange-Who, Why, What, How

• Who Payers
• Priority 1 (Highest risk category) Contact all
  payers who currently assign legacy group
  numbers and legacy individual numbers
• Contact top 20 payers which represents 80 of our
  claim volume
• Contact our clearinghouse to determine how they
  will handle incoming and outgoing NPIs
• Next Step communicate to all other payers

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Exchange-Who, Why, What, How

• Why Ensure Payment Continuity
• NPIs will replace all existing payer assigned
  legacy numbers and
• Providers chose how they want their subparts
  enumerated therefore
• Granularity of subpart NPIs can have payer
  reimbursement implications
• Payers need to cross-map their legacy numbers to
  NPIs (many to one one to many situations)

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Exchange-Who, Why, What, How

• What - Needs to be Exchanged
• Type I (Individual Providers)
• One to One match (most payers)
• Type II (Organizations and Subparts)
• Many times not a One to One match
• Providers should communicate/collaborate with
  payers their Type II NPI-to-Legacy ID
  relationships prior to exchange file

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Exchange-Who, Why, What, How

• Type II NPI to Legacy Relationship Communication
• Determine subpart enumeration schema
• Identify payers who currently assign legacy group
  numbers and determine gaps
• Payers currently requiring more granularity in
  enumeration
• Payers who would need to process additional
  numbers
• Determine whether there are contract implications
  changing granularity

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Exchange-Who, Why, What, How

• Type II NPI to Legacy Relationship Communication
• Payer should send a list of existing group
  numbers maintained in their database to be
  matched with the numbers a provider submits
  resolve discrepancies
• Review subpart schema with payer address claim
  data elements that might be needed for
  reimbursement (i.e. zip code, taxonomy code, etc)

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Exchange-Who, Why, What, How

• How Exchange Mechanisms
• Different methods of NPI exchange may be required
  based on payer (i.e. Web, Excel file, ENUF,
  paper)
• Some payers indicate they will do their crosswalk
  on the fly with Type I NPIs based on submitted
  claims
• Can your billing system accommodate dual number
  submission?
• Will your vendor deliver their NPI solution
  timely enough so adequate time is allowed for
  payers to do their crosswalk on the fly?
• Many organizations were planning to populate
  their systems from the NPPES system

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Exchange-Who, Why, What, How

• How To Begin Process for Exchange
• Develop project plan for exchange and testing
  process
• Determine what is expected by each payer
• Check payer web sites and watch payer bulletins
• Contact payers directly
• Monitor MN Collaborative Web Site

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Exchange-Who, Why, What, How

• Questions to Have Answered
• Payer contact info
• Determine how currently paid by payer (tax id or
  legacy number)
• Exchange options both Type I and II
• What data elements are necessary
• Payers system readiness to accept NPI
• Will there be new paperwork required

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Exchange-Who, Why, What, How

• Additional Questions to Have Answered
• When will the payer be ready to accept claims
  with NPIs (test and production timelines)
• Does payer plan to use taxonomy codes
• Will payer provide remit (end-to-end) testing
• When will payer incorporate NPI into their web
  system for eligibility and claim status
• What is the payers implementation timeline for
  the UB04 and CMS 1500 updated form

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Exchange-Who, Why, What, How
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Exchange-Who, Why, What, How

• Another Who Category Provider to Provider
• Exchange between providers with common
  practitioners
• Exchange between providers for referring
  physician NPI information
• Exchange between physicians with admitting
  privileges and the hospital
• Exchange between prescribing physician and
  pharmacy

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Exchange-Who, Why, What, How

• The actual enumerating process is the easy part
  of NPI implementation for providers.
• Communicating, exchange and testing is the most
  critical and time consuming process. Failure to
  devote time to these processes may put a
  providers reimbursement at risk.