Jean FeinsteinLyon, Department of Health and Family Services

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NPI Implementation from a Payers Perspective

• Jean Feinstein-Lyon, Department of Health and
  Family Services
• LuAnne Green, EDS

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Best Practices

• Build in flexibility to handle provider
  enumeration decisions
• Develop a system solution that accommodates
  competing timelines
• Identify and modify affected business processes
• Make NPI education a high priority
• Stay informed of industry issues and
  recommendations

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Lessons Learned

• Do not wait for the silver bullet
• NPI implementation is more complicated than it
  appears
• Information in addition to the NPI may be needed
  to accurately process transactions
• Accurate conversion is critical
• Have a contingency plan

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Best Practice 1 Build in Flexibility to Handle
Provider Enumeration Decisions

• Enumeration impacts policy
• Payers cannot tell providers how to enumerate
  themselves

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Best Practice 2 Develop a solution that
accommodates competing timelines

• Federal initiatives
• State initiatives
• Trading partners
• NPI delays

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Best Practice 3 Identify and Modify Affected
Business Processes

• NPI is more than an IT issue
• NPI impacts all business processes
• Inform providers and trading partners of changes
  in business processes

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Best Practice 4 Make NPI Education A High
Priority

• Train internal organization early
• NPI rules
• System solution
• Educate business partners
• Changes in business processes
• Requirements for paper and electronic
• Implementation timeline

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Best Practice 5 Stay Informed of Industry
Issues and Recommendations

• Leverage the work already done by other
  organizations
• Utilize available resources
• Web sites
• White papers
• Listservs

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Lessons Learned 1 Do not wait for the silver
bullet

• Every organizations needs are different
• Nobody is going to provide the magic answer or
  solution
• No solution, besides hard work, will assure a
  successful implementation

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Lessons Learned 2 NPI implementation is more
complicated than it appears

• NPI requires more than just a technical solution
• Scenarios are endless and the impacts are far
  reaching

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Lessons Learned 3 Information May Be Needed
Beyond NPI to Accurately Pay Claims

• Challenges of electronic versus paper claims
• Other information, such as taxonomy, address or
  zip code, may be needed
• Different scenarios require different solutions

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Lessons Learned 4 Accurate conversion is
critical

• Multiple legacy numbers to one NPI
• Accurate identification of providers for
  conversion
• Errors in conversion have consequences

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Lessons Learned 5 Have A Contingency Plan

• Not paying claims is not an option
• Dont assume that everybody will be ready by
  5/23/07
• Plan for ongoing technical assistance to trading
  partners

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Challenges

• Need to continue to issue and maintain
  proprietary provider numbers for non-healthcare
  providers
• Subpart enumeration
• Taxonomy
• Need system intelligence to connect the NPI and
  legacy number to the same entity

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Approach

• Develop system solution
• Crosswalk taxonomy
• Analyze all system outputs
• Review business processes
• Analyze all policies

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Questions?