|
|
May 23, 2006 |
BC-06-08 |
HHA-06-06 |
| To: | All Blue Cross Contracting Providers and Other Facility Providers Located in Kansas |
| From: | Donna Bartee, Communications Representative Institutional Relations Blue Cross and Blue Shield of Kansas An Independent Licensee of the Blue Cross and Blue Shield Association |
| Subject: | National Provider Identifier |
Most of this newsletter is intended for providers who have not notified BCBSKS about their NPI and taxonomy codes. Blue Cross and Blue Shield of Kansas first began telling institutional providers about the NPI process last August. Since then we have developed internal processes that should insure a successful conversion by BCBSKS to national provider identifiers. Our success however depends in part on providers and their timely application for NPIs (and taxonomy codes) and most importantly sharing that information with BCBSKS. Without this information, BCBSKS will not be able to accept, process or pay claims. This newsletter includes information about NPIs that we hope most providers already know. If you don’t, there’s still time:
PROVIDER CHECK LIST
WHAT IS AN NPI? An NPI is a universal ten-digit number and will be used to submit electronic transactions to all payers. It will eventually replace all of your existing provider numbers. You will no longer have a different provider number for each payer. Every payer will use the same number. WHAT’S TAXONOMY CODE? A taxonomy code is a 10-character code that identifies the type of medical provider and their specialty. Information about taxonomy codes is available at the Washington Publishing Company Web site http://www.wpc-edi.com/. A taxonomy code is required for each NPI. The online NPI application may not require a taxonomy selection; however, we understand that a taxonomy code will be assigned by NPPES based on the information on the provider’s application. To retrieve the taxonomy code, providers will need to log in the NPPES and view their profile. When you tell BCBSKS what your NPI is, you will also need to tell us what the taxonomy code is. If more than one taxonomy code applies, please report all codes to BCBSKS. Just to give you an idea what a taxonomy code looks like, here’s two examples:
May 23, 2007 is the national date that electronic transactions must begin using NPIs. BCBSKS may implement prior to this date but will announce our final decision later. Between now and then:
IS THERE MORE THAN ONE TYPE OF NPI and WHAT’S THE DIFFERENCE? Yes and when you notify BCBSKS what your NPI(s) is, we need to know what type it is. The choices are:
Organization – must be operating as a legal entity and includes but is not limited to group practices, ambulatory surgery centers, clinics, retail pharmacies, DME suppliers/stores, home health agencies, hospitals, and any other qualifying health care entity. The organization may obtain NPIs for its subparts. Subparts – are not legal entities. The subpart designation applies only to a department within a larger organization. The organization determines whether to enumerate the subpart(s) within their organization. HOW TO APPLY FOR AN NPI The National Plan and Provider Enumeration System (NPPES) handle NPI applications. The online application and NPI application help guide is available at their Web site: The Centers for Medicare & Medicaid Services also has an instructional web tool called NPI Viewlet. This tool gives an overview of the NPI and a walkthrough of the application process. http://www.cms.hhs.gov/NationalProvIdentStand/04_education.asp#TopOfPage LISTING OF BCBSKS PROVIDER NUMBERS We thought it might be helpful if institutional providers had a complete listing of the active BCBSKS provider numbers (facility and professional numbers) that are assigned to their tax identification number. We mailed a listing to you last fall and if you haven’t already sent us your NPI information, we’ll send a current list to you within the next two or three weeks. For each active provider number in the BCBSKS system, we will need an NPI. NOTE: Hospital-based providers (i.e. home health, hospice, etc.) will not receive a separate list. The complete list will be sent to the base hospital. TELL BCBSKS WHAT YOUR NPI(s) AND TAXONOMY CODES ARE NPI numbers will eventually replace all of your existing provider numbers including those assigned to you by BCBSKS. Like most insurance carriers, BCBSKS is building a “crosswalk” within our claims system to link current provider numbers to the new NPIs. This file has to be completed before NPIs are submitted on claims. PROVIDERS NEED TO NOTIFY BCBSKS ABOUT THEIR NEW NPI(s) NO LATER THAN OCTOBER 1, 2006. You also need to include the taxonomy code. If you don’t tell us what your NPI number is, we won’t be able to process claims or issue checks.
When we receive your NPI information we’ll share it with other areas at BCBSKS including EDI Blue Cross and Blue Shield of Kansas and Blue Shield professional relations. Mail information to: Fax information to: Institutional Provider Relations Excel spreadsheets can be emailed to:
FOR MORE INFORMATION ABOUT NPI(s)
WHAT IF I HAVE QUESTIONS? The Centers for Medicare & Medicaid Services has contracted with Fox Systems, Inc. to serve as the NPI enumerator. The NPI enumerator is responsible for dealing with health plans and providers on issues relating to unique identification. They can be contacted as follows:
|