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NPI Use in Transactions

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Title: NPI Use in Transactions

1
NPI Use in Transactions

For both commercial and Medicare Crossover
business, BCBSNC has targeting three NPI phases
Dual AcceptanceTrading Partners may send
claims with NPI as long as PPN (Legacy Provider
ID) is also sent. No processing using NPI.
Started for commercial 1/2006. Started for
Medicare Crossover 5/2006.
Dual UseProviders that have registered their
NPI(s) with BCBSNC may send transactions using
PPN only, NPI only, or both. We recommend that
if the provider wants to send NPI, the provider
also send PPN. Started for commercial 10/2006.
ComplianceTransactions with PPNs in fields where
only the NPI is permitted will be rejected.
Compliance is targeted for 5/23/2007.
We have created and are using a crosswalk of the
providers PPN to NPI relationships.

2
NPI Collection

BCBSNC has never planned to use NPPES data.
BCBSNC also chose not to collect directly from
837s. We do work a report from 837s with Dual
IDs.
We have three methods for NPI collection
PaperIn Q2 2006 we sent a set of request letter
mailings directly to our providers, both
participating and non-participating. We sent a
second request to participating providers in
early Q4 2006. We accept our letters back, or
letterhead with appropriate signatures. We send
confirmation letters once we have loaded our
crosswalk.
Web PortalProviders that already have secure
access to our provider portal have been able to
register their NPI(s) with BCBSNC online since 2Q
2006. We send confirmation letters once we have
loaded our crosswalk.
MS Excel SpreadsheetCertain large providers
already send spreadsheets with provider data
changes. We added the ability to include NPI in
the set of provider data. We email back once we
load the data into our crosswalk.
When an issue with loading NPIs occurs, our
Provider Network team contacts the providers
directly.

3
NPI Collection Discoveries

Interesting comments
What is an NPI?
Why do I need a type 2?
Why do I need a type 1?
Why are you bothering me with something that is
18 months away?
My vendor/clearinghouse will make me compliant.
The date will be extended.
Let me concentrate on Medicare.
Ill just get one (when there are multiple
contracts), you keep working with me the same
anyway.
Medicare will tell me (force me) how to
enumerate.
Too many payers are asking me for the same thing.

4
NPI Testing

BCBSNC does not have a testing environment that
perfectly mirrors the data in our production
environment. Therefore, we do not test trading
partners transactions directly in a test
environment.
We use a 3rd party tool to confirm that
transactions will pass standard HIPAA edits.
We have conducted an NPI Pilot in 4Q 2006. We
have included providers and trading partners with
whom our EDI team has a relatively good
relationship.
Includes confirming crosswalk contents,
transaction receipt, IG pass, crosswalk
translation, internal formats mapping, arrival in
the adjudication systems, payment, paper
Notification of Payment, and 835 creation
Tests internal business process changes
Trading partner and provider expectations are met
Once we declare victory in the pilot phase
(estimate this Friday), we will start our
migration phase.

5
NPI Testing Discoveries

Many providers and trading partners said they
would be ready in 4Q 2006 to participate in
pilots. Only 8 actually were.
Everything must align perfectly to be successful
Provider must have NPI, must register NPI with
BCBSNC
Provider software changes to support 837 (vendor)
Trading Partner software changes to support 837
(clearinghouse)
Trading Partner software changes to support 835
(clearinghouse)
Provider software changes to support 835 (vendor)
Our Medicare Crossover trading partner is sending
NPIs on some 837s. When a provider on the
Crossover has an NPI that is not registered with
BCBSNC, we call them (please register). Those
providers have been shocked and perturbedthey
are not sending NPI on their Medicare claims.

6
NPI Migration

Phase 1Invitations
We will contact providers where their
clearinghouse or software vendor indicates
readiness and invite them to start using NPI.
Provide will contact us.
Manual process with less verification.
Phase 2Open for any provider that has
registered.
Automated loads from our NPI system to our EDI
authorization system
Formal announcement to provider community