NPI Reporting Requirements for 5010
On May 2, 2011, Gateway EDI posted an article regarding NPI reporting requirements for 5010. Their article answered a list of frequently asked questions about 5010 and NPIs – answers to some of your questions may be on the list!
Here is the complete article:
5010: NPI Reporting Requirements
In the Health Insurance Portability and Accountability Act (HIPAA) 5010 transition, the National Provider Identifier (NPI) unique identification number for health care providers is becoming part of uniform reporting requirements. Providers will be required to use the same billing NPI across all insurance payers, so this change has critical impact on claim transactions and billing practices.
Gateway EDI strongly encourages contacting all your current payers to confirm what NPI is currently being submitted. You may need to review all your billing systems to ensure consistent usage of NPI. Completing any steps needed prior to the January 1, 2012, compliance deadline will help ensure a smooth transition to 5010.
Answers to frequently asked questions about 5010 and NPIs are below. Our goal for 5010 is to make this transition as seamless as possible for you. We are here to help you along the way. We will continue to support all our clients as we do today.
Why is it important to use a consistent billing NPI when filing 5010 claims?
By using the same NPI for all payers, providers will no longer have to modify their billing NPI based on the payer being sent a specific claim. This new requirement will also help payers that receive crossover or secondary claims, by eliminating the need to identify providers differently than they do when receiving primary claims.
Will the 5010 NPI requirements affect the reporting of our billing NPI?
The new guidelines focus on creating uniform reporting of billing NPIs to all payers. Providers who are not consistently reporting the same NPI with all payers may be required to re-examine their current billing practices and adjust accordingly.
Will I still be able to use an individual NPI when billing?
A billing NPI is most commonly an organizational NPI. Once 5010 is in place, individual NPIs will only be allowed to be sent as the billing NPI when services were performed by, and will be paid to, an independent, non-incorporated individual.
Will all payers enforce NPI consistency as of January 1, 2012?
Some payers may continue to accept different NPIs, making advance communication with payers an important step in your planning. While NPI consistency is a key component of 5010, it is at the payers’ discretion to enforce it. There is not a regulating body over the use of NPIs.
Will I have to re-enroll if we decide to change our billing NPI with a particular payer?
Re-enrollment is necessary if your practice decides to change the NPI you are submitting to a particular payer.
What can I do now to ensure my billing NPI is consistent?
Review your billing system to identify what NPI your office sends to each payer. Communicate the differences in NPI reporting to those in your office responsible for billing and determine what NPI your office should be using for claims. Then you can contact the payers’ provider relations offices to verify what steps to take in order to update your billing NPI with their organizations.
What should I do if I determine that I do need to make changes to my billing NPI?
If changes need to be made, communicate this information as soon as possible to your trading partners, including clearinghouses, payers, software vendors and other business partners. They may need to make changes to their systems so they can recognize a different billing NPI and associate it with your practice. This is an important step to complete well in advance of January 1, 2012, to provide adequate time for new enrollment forms to be processed, if needed.
Please visit the Gateway EDI 5010 web page for up-to-date information at www.gatewayedi.com/5010. For additional questions, contact our 5010 team at industryinfo@gatewayedi.com.