National HIPAA Audioconference: Analysis of the National Provider Identifier

1. National HIPAA Audioconference: Analysis of the National Provider Identifier Preparing for the NPI Transition January 11, 2006

2. Preparing for the NPI Transition • Individual Providers • If employed by an Organizational Provider • Ask how/if employer plans to enumerate employed providers • What education will be made available? • What is required of employed providers? • Do I need an NPI?

3. Preparing for the NPI TransitionProviders • Individual Providers • Private or Group Practice • Do I need an NPI? (Most providers will) • How will I apply for an NPI? • Gather data requirements • https://nppes.cms.hhs.gov/NPPES/Welcome.do • Follow instructions carefully • Use legal name • Use standardized address (NPPES assisted) • Educate yourself on short and long term uses of the NPI • Own the process

4. Preparing for the NPI TransitionProviders • Organizational Providers • Organize Implementation Team • Implementation Team – Core Members • Business Office (PFS) Manager(s) • Revenue Cycle Director / Executive • Medical Staff / Credentialing • Corporate Compliance Officer • Information Technology (Clinical and Financial) • Managed Care

5. Preparing for the NPI TransitionProviders • Implementation Team – Ad Hoc Members • Chief Medical Officer • Ancillary Department Managers • Clinic Managers • Health Information Management • Human Resources • Legal • Training and Staff Development / Education

6. Preparing for the NPI TransitionProviders • Immediate education • Core implementation team • Develop project plan with milestones • Identified affected departments/ business units • Identify affected Trading Partners and Business Associates • Identify affected processes, policies, and procedures (Don’t forget Medical Staff By-Laws)

7. Preparing for the NPI TransitionProviders • Develop transitional strategies • Application • Enumeration (Subpart delineation) • Contract Review • Regulatory Requirements • Education • Employed Providers • Medical and Allied Staff • Referring Providers

8. Preparing for the NPI TransitionProviders • Transitional Strategies (continued) • Taxonomy? • Disclosure • NPI Collection (Dissemination) • Validation • Testing • The Application Gap • Referrals • Pharmacy

9. Preparing for the NPI TransitionProviders • Information Systems • Gap Analyses • NPI • Taxonomy • Legacy Identifiers • Interfaces • Reports - Internal and External • Document Imaging / Archiving Technologies • Clinical • E-Prescribing • EHR / EMR • Software updates

10. Preparing for the NPI TransitionProviders • Communicate, Ask, Educate • Health Plans • Software vendors • State / Federal Agencies (data submission) • Third-party vendors (data submission) • Other Business Associates

11. Preparing for the NPI TransitionPayers • Payers • Assemble implementation team • Credentialing • Authorizations / Medical Management • Claim Processing (Electronic/DDE/Paper) • Finance • Remittance Advice • Premiums • Beneficiary Enrollment • Information Technology

12. Preparing for the NPI TransitionPayers • Determine affected processes / departments • Plan / product line specific • Coordination of Benefits • Subparts and the lack of subparts (The Granularity Issue) • Provider Services • Legal • Provider Contracts • Workflow • System • Mail Room

13. Preparing for the NPI TransitionPayers • Determine affected processes / departments (continued) • Web Services • Clearinghouses • Settlements • Reporting • Fraud and Abuse • Ten digits of gloriously meaningless pixels / ink

14. Preparing for the NPI TransitionPayers • Develop Strategies • Conversion / Crosswalk / Other • Adjudication Methodologies and related processes • The Application Gap • Post-implementation legacy/NPI support • NPI data collection • NPI data validation • Sequencing of software updates and transactions • Testing • Implementation schedule

15. Preparing for the NPI TransitionPayers • Develop Strategies (continued) • Inbound validation • Pharmacy Transactions (PBMs) • When is legacy compliant? • The Application Gap • Communicate, Ask, Educate • Providers • Clearinghouses • Software vendors • State / Federal Agencies (data submission) • Other Business Associates

16. Preparing for the NPI TransitionVendors • Vendors • Claim Clearinghouses • Software Vendors • Data Clearinghouses • Data Warehouses • Develop Implementation Strategies • Education • Must be ready before customers • Software updates • Testing

17. Preparing for the NPI TransitionVendors • Develop Implementation Strategies (continued) • Conversion / Crosswalk / Other • NPI validation (Luhn only?) • Sequencing of software updates and transactions • Testing • Implementation schedule • EVERYONE will be ready at different times • Support of Dual Identifier Testing Strategy

18. Preparing for the NPI TransitionVendors • Ask, Ask, Communicate, Educate • Payers • Providers • Other Trading Partners • Other Business Associates

19. Preparing for the NPI TransitionVendors • The Application Gap • Post-implementation legacy/NPI identifier support issues

20. Preparing for the NPI Transition • Common Threads • Communication • Asking • Education • The Granularity Issue • The Application Gap • Our patients, beneficiaries, and their families

21. Preparing for the NPI Transition Michael Apfel Chief Privacy Officer Truman Medical Centers • WEDI National Provider Identifier Outreach Initiative Steering Committee • Co-chair, Education and Content Work Group WEDI National Provider Identifier Outreach Initiative Michael.Apfel@tmcmed.org