HIPAA Collaborative of Wisconsin Fall 2007 Conference

1. HIPAA Collaborative of Wisconsin Fall 2007 Conference NPI: Contingency Plans and Data Dissemination Suzanne Stewart, EDI Coordinator Aurora Health Care Milwaukee, WI

2. Agenda: NPI The Road That Lies Ahead • General Information about Aurora • The Contingency Road Map • Smooth Roads – Positives • Pot Holes – Negatives • Building the Contingency Road Map • Detours • Under Construction – Data Dissemination • What roads are Aurora planning to travel? • 1st Stop: NPI Registry • 2nd Stop: NPPES Download File

3. Aurora Health Care • Aurora has sites in more than 90 communities throughout eastern Wisconsin, including 13 hospitals, more than 100 clinics and 120 community pharmacies. More than 3,400 physicians are affiliated with Aurora Health Care, including more than 680 who make up Aurora Medical Group. • Other services include laboratories, home care and hospice, quick care and more. • 10 billing systems producing 7,000,000 claims electronically annually

4. The Contingency Plan Map • Smooth Roads – Positives of Contingency • Continuation of Transactions with little disruption to cash and business process flow • Allows additional time for testing to assure appropriate transaction processing • Continue to collect NPIs for secondary providers • Gives additional time for Data Dissemination and Information Exchange

5. The Contingency Plan Map • Pot Holes: Negatives of Contingency • Coordinating trading partners for varying end of contingency dates • Some felt the compliance guidance was a free pass to slow down on the NPI project • Had to address “hiccups” with NPI-related rejections with Trading Partners (I.e. Edits that were supposed to be removed)

6. The Contingency Plan Map • Pot Holes: Negatives of Contingency • Additional Costs – Staff who thought the bulk of their work would be completed by May 23, 2007, is now extended: • IS • Project Leads • Provider Activation • Business Office

7. The Contingency Plan Map • Building the Contingency Road Map • Creating timelines for legacy id use, dual use and NPI only use • Communicating and working with payers on contingency • Document all good faith efforts to date, and update every 2 months • Address missing NPI related information

8. The Contingency Plan Map • Detours • Physician Quality Reporting Initiatives (PQRI) • Present on Admission (POA) • Updating NPI records, NPPES • Issues: • Related to Paper Claim Forms • NPI Contingency – edits/rejections • Remittance issues due to NPI crosswalks

9. Under Construction – Data Dissemination • What roads is Aurora planning to travel? • Created reports for each System regarding: • Primary Provider’s missing NPI • Secondary Provider’s missing NPI • Use Data Dissemination Download file for NPI verification • Gap fill missing NPIs with Download and NPI Registry • New Providers: Look-up functionality

10. Under Construction – Data Dissemination • 1st Stop: NPI Registry https://nppes.cms.hhs.gov/NPPES/Welcome.do • Expected this sooner, didn’t happen until Sept. 4th • How did the data look? • What issues did we see? • Did the registry fulfill our needs?

11. Under Construction – Data Dissemination • 2nd Stop: NPPES Download File http://nppesdata.cms.hhs.gov/cms_NPI_files.html • Expected this sooner, didn’t happen until Sept. 11th • Size of Files: Est. 340MB Compressed/zipped • Length of time it will take to take the file and load into our NPI DB? • Timeliness of update files: once a month

12. Suzanne Stewart EDI Coordinator, Aurora Health Care Milwaukee, WI suzanne.stewart@aurora.org 414-647-3398