If a health care provider with a National Provider Identifier (NPI) moves to a new location, must the health care provider notify the National Plan and Provider Enumeration System (NPPES) of its new address? For eRx, see the Claims-Based Reporting Principles for eRx, available on the CMS eRx website. This is available as a download from the Measures/Codes section of the CMS PQRI website. See the PQRI Implementation Guide for a sample CMS-1500 claim. If a group NPI is used at the claim level, the individual rendering physician’s NPI must be placed on each line item, including all allowed-charge and quality-data line items. The PQRI/eRx QDC must be included on the same claim that is submitted for payment at the time the claim is initially submitted in order to be included in PQRI analysis. Your individual National Provider Identifier (NPI) must be included on the claim line items for the quality-data codes (QDCs) you submit as well as the line items for the services to which the QDC is applicable. How does a rendering physician report their National Provider Identifier (NPI) on a claim that includes Physician Quality Reporting Initiative (PQRI) or Electronic Prescribing Incentive Program (eRx) quality-data codes (QDCs)? What if he/she is part of a group and the group NPI is used on the claim? Their tax ID number should not be included.įor eligibility, claim status inquiry, referral and precertification, only the NPI (no tax ID number) is used. Any other providers identified on the claim, such as rendering provider or service facility, must be identified with their NPI only. The billing provider’s tax ID number and NPI are always required on claims. To deactivate an NPI, a health care provider (or the trustee/legal representative of a health care provider) must complete a CMS-10114 and mail it to the NPI Enumerator. There also may be situations where a new NPI is necessary because the current NPI was used for fraudulent purposes.Ī health care provider (or the trustee/legal representative of a health care provider) should deactivate its NPI in certain situations, such as retirement or death of an individual, disbandment of an organization, or fraudulent use of the NPI. There are some situations, however, in which an NPI may change such as when health care provider organizations determine they may need a new NPI due to, for example, certain changes of ownership, the conditions of a purchase, or a new owner’s subpart strategies. The National Provider Identifier (NPI) is meant to be a lasting identifier, and is expected to remain unchanged even if a health care provider changes his or her name, address, provider taxonomy, or other information that was furnished as part of the original NPI application process. ![]() The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.Īs outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a unique identification number for covered health care providers. The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. Image by Oberazzi via Flickr What is a NPI again?
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |