National Provider Identifier Industry Forum Use of NPI on 1500 Claim Form

Transcription

1 National Provider Identifier Industry Forum Use of NPI on 15 Claim Form Presented by Jean P. Narcisi NUCC Chair

2 Results of the 15 Claim Form Public Comment Period

3 Number of by Days of Comment Period Number of June 1 June 13 June 16 June 19 June 22 June 25 June 28 July 1 July 4 July 7 July 1 July 13 July 16 July 19 July 22 July 25 Date

4 Percentages of by Category Other - Multiple 5% Other Organization 9% Provider Health Plan Vendor 19% Provider 51% Vendor Other Organization Other - Multiple Health Plan 16%

5 by Categories of Providers Other 14% Home Care 2% Clinic 6% Hospital 12% Solo 33% Solo Group Hospital Clinic Home Care Other Group 33%

6 Providers that Responded Cleveland Clinic Foundation Mayo Clinic Allina Hospitals and Clinics Children s Hospitals and Clinics Fairview Hospital and Health Care Services Hennepin County Medical Center Hennepin Faculty Associates Park Nicollet Health Services North Side Medical Clinic Bayhealth Medical Center Carolina Regional Cancer Center River Crest Hospital Susquehanna Health System HealthEast Care System St. Mary s/duluth Clinic Health System University of Minnesota Physicians University of Minnesota School of Dentistry Universal Health Services UHS of Pennsylvania, Inc. Osceola County EMS Talbott Recovery Campus MediServ, Inc.

7 Providers that Responded (cont.) Partners in Primary Care Digestive Health Management Richmond Radiologists, Inc. Radiology Associates of San Antonio, PA South Texas Radiology Group, PA Radiology Associates of Muncie, Inc. Metropolitan Pain Management Consultants, Inc. Endocrinology Associates of Houston Happyland Pediatrics 1 Solo Practitioners Athens Regional Home Infusion Infusion Partners Greenwood Genetic Center Fond du Lac Human Services Division Jefferson County Human Services Rehab Alliance Physical Therapy and Fitness Therapy in Motion Archibold High Tech Services, Inc. EyeMart Express Laboratory Corporation of America

8 by Categories of Health Plans Other 19% Medicare 6% Medicaid 31% Medicare Medicaid Commercial Other Commercial 44%

9 Health Plans that Responded CMS Noridian Administrative Sevices, LLC Medicare Part A Wisconsin Physician Services Medicare Part B Virginia Medicaid State of Idaho Medicaid California Medicaid Electronic Data Systems Department of Health and Hospitals Department of Health and Social Services Department of Veterans Affairs-HAC UnitedHealth Group Highmark, Inc. Blue Cross Blue Shield of Alabama Blue Cross Blue Shield of Florida Blue Cross Blue Shield of Minnesota Delta Dental Plan of Minnesota HealthPartners Medica Health Plan Preferred One UCare Minnesota Metropolitan Health Plan ACS Benefit Services, Inc The Regence Group Sagamore Health Network Wisconsin Physician Services Insurance Corporation Excellus Health Plan

10 by Categories of Vendors Other 5% Software Vendor 16% Clearinghouse 21% Provider IS Support 42% Provider IS Support Billing Service Clearinghouse Software Vendor Other Billing Service 16%

11 Vendors that Responded McKesson Siemens Medical Solutions Health Services Corporation Misys Healthcare Systems Medata, Inc. MEDTRON Software PDS E-Z BIS, Inc. Accu-Med Services Medispec Management Services, Inc. Allwin Data Per-se Technologies, Inc. Clinix MIS Anexix, Inc. Physician s Computer Company Electronic Data Systems Tele Comm Computer Systems, Inc. QuadraMed Specialized Clinical Services

12 Others that Responded CHAMPUS/TRICARE American Urological Association American College of Physicians American Association of Oral and Maxillofacial Surgeons American Psychological Association National Association of Social Workers American Health Information Management Association American Association of Healthcare Administrative Management Ingenix Connolly Strategies & Initiatives NextGen Health Information System Saltzer Medical Group Minnesota Hospital Association Minnesota Medical Association Minnesota Medical Group Management Association Minnesota Pharmacists Association Minnesota Dental Association Minnesota Department of Health Minnesota Department of Human Services Minnesota Department of Labor and Industry Minnesota Uniform Billing Committee Midwest Center for HIPAA Education HCPCS Committee Health Care Payer and Provider Advisory Council

13 We are targeting October 1, 26 as the earliest start date for the proposed 15 Claim Form. Indicate the amount of time your organization will need to plan and prepare for the switchover < 6 months 6-9 months 1-12 months months > 24 months

14 Proposed Transition: October 1, 26 February 1, 27 providers can use either 15 form (current and proposed); February 1, 27 current for discontinued and only the proposed form can be used. Please indicate your preference for a transition window No transition 4 month transition 6 month transition Other

15 If no, please identify an alternate transition. 6 months 1 year 12 months months 24 months February 1, 27 May 23, 27 May 23, 27 to coincide with NPI deadline Never

16 Do you agree that the targeted 27 compliance date should be February 1, 27? Yes No

17 If no, please identify an alternate date. October 26 January 1, 27 (4) April 1, 27 (2) May 23, 27 (7) May 27 or later June 1, 27 October 1, 27 Late 27, early 28 January 1, 28 (3) February 1, 28 or later 29 Never

18 Indicate the overall level of importance of the proposed changes to the 15 form for facilitating migration to the NPI and Health Plan Identifiers Extremely vital Important Neutral Marginal Not important

19 PROVIDER - Please estimate the cost for the 15 form conversion for your organization <1K 1-5K 5-1K 1-25K 25-5K >5K Other

20 HEALTH PLAN - Please estimate the cost for the 15 form conversion for your organization <1K 1-5K 5-1K 1-25K 25-5K >5K Other

21 VENDOR - Please estimate the cost for the 15 form conversion for your organization <1K 1-5K 5-1K 1-25K K >5K Other

22 PROVIDER - When will your system be able to support both the legacy payer ID and NPI numbers? Now 1-Jan- 6 1-Jun- 6 1-Oct- 6 1-Jan- 7 Other

23 VENDOR - When will your system be able to support both the legacy payer ID and NPI numbers? Now 1-Jan- 6 1-Jun- 6 1-Oct- 6 1-Jan- 7 Other

24 PROVIDER - Will your budget cycle accommodate the February 27 timeline? Yes No

25 PROVIDER - Are there any other implementation timeline considerations besides budget? Software modifications needed Vendor readiness Insurer readiness Training Staffing Vendor/Payer/Clearinghouse coordination Testing the form with all carriers Using up the old forms so as not to waste money Using software that won t accommodate the new form and can t afford to upgrade Internal plan to implement a new operating system and electronic medical record Coordination with MIS Application for NPI Extensive system enhancements necessary will cause issues with other information system priorities

26 HEALTH PLAN - Will your budget cycle accommodate the February 27 timeline? Yes No

27 HEALTH PLAN - Are there any other implementation timeline considerations besides budget? Programming and testing Implementation of UB-4, NPI Final Rule, and other HIPAA transaction changes that may occur Mandates from federal, state, and other regulatory bodies within the same timeframe Conversion from a old legacy processor to a new relational database processing system Provider and staff education System readiness both claims processing and scanning Scheduling the systems work Claims contractors have to adjust their systems Providers have until May 27 to get their NPI, so there may be providers who don t have their NPI yet

28 PROVIDER - Are there any specific modifications to the 15 form that will cause undue hardship or conflict with any regulatory or contractual obligations? Yes No

29 PROVIDER - Please indicate the modifications that will cause undue hardship or conflict with any regulatory or contractual obligations Managed care contracts could be an issue Possibly having to maintain use of old provider numbers from health plans as well as use of newer NPI and the mapping of this information will create a hardship New software update The proposed changes are an unnecessary burden to providers, billers, and payers of medical services Major expense in either buying a new computer system or we would have to manually type every claim

30 HEALTH PLAN - Are there any specific modifications to the 15 form that will cause undue hardship or conflict with any regulatory or contractual obligations? Yes No

31 VENDOR - Are there any specific modifications to the 15 form that will cause undue hardship or conflict with any regulatory or contractual obligations? Yes No

32 PROVIDER - Will delaying the implementation of the proposed 15 form changes cause a hardship to your organization? Yes No

33 HEALTH PLAN - Will delaying the implementation of the proposed 15 form changes cause a hardship to your organization? Yes No

34 PROVIDER Please indicate the percentage of paper claims submitted per year <1% 1-5% 5-1% 11-2% >2%

35 PROVIDER Indicate the change in paper claims you expect to see over the next two years Significant decrease Slight decrease Same Slight increase Significant increase Unknown

36 HEALTH PLAN Please indicate the percentage of paper claims submitted per year <1% 1-5% 5-1% 11-2% >2%

37 HEALTH PLAN Indicate the change in paper claims you expect to see over the next two years Significant decrease Slight decrease 7 7 Same Slight increase Significant increase 7 Unknown

38 VENDOR Will you charge your customers for the costs associated with the conversion to the proposed 15 form? Yes No

39 VENDOR How much time will your organization need to incorporate the 15 form changes? < 3 months 3-6 months 7-12 months months > 18 months

40 to Form Specific Changes: The barcode header was removed Agree Disagree Other comments 7

41 NUCC logo and approval information was added to the left-hand side of the header Agree Disagree Other comments

42 Box 17a was split to accommodate the Other ID# and the NPI# of the referring or ordering provider in box 17a and 17b Agree Disagree Other comments

43 Box 24C was changed from Type of Service to EMG Agree Disagree Other comments

44 Box 24D became a wider field by 3 bytes Agree Disagree Other comments 6

45 Box 24E became a narrower field by 3 bytes and the heading was changed from Diagnosis Code to Diagnosis Pointer Agree Disagree Other comments

46 Box 24I is now labeled ID Qualifier. It was originally labeled EMG. However, EMG is now located in box 24C. Box 24C was previously labeled Type of Service, which has been eliminated Agree Disagree Other comments

47 Box 24J for COB was removed Agree Disagree Other comments

48 Box 24K was relabeled as 24J Agree Disagree Other comments

49 Boxes 24I and 24J were split to accommodate the Other ID# and the NPI# of the rendering provider. The top half of the field will accommodate a legacy provider ID# and the NPI# will be on the bottom half of the field Agree Disagree Other comments

50 Shading was added to the top half of the lines in field 24. Supplemental information is to be entered in the shaded areas. Required information is to be entered in the unshaded areas Agree Disagree Other comments

51 Boxes 32a and 32b were added in box 32 to accommodate the NPI# (32a) and a legacy provider ID# (32b) Agree Disagree Other comments

52 In box 33, the PIN# box was changed to 33a for the NPI# and the GRP# box was changed to 33b for the legacy provider ID# Agree Disagree Other comments

53 Questions? Thank You!