May 2006 Newsletter

HARP Gears Up for NPI, Revised CMS-1500, and UB-04

By: VP, Implementation and Support, A/R Services

Planning and development are underway to accommodate the implementation of National Provider Identifiers (NPI) in HARP. A Quadax team has been accumulating and digesting NPI news and instructions from the Centers for Medicare & Medicaid Services (CMS) and third-party payers.  Additionally, we have been researching and preparing for the revised CMS-1500 and new UB-04 claim forms.

As outlined in the CMS Change Request #4230 dated February 1, 2006, Medicare is using a four-stage process for implementing the NPI. Below is a brief summary of these stages:

Stage 1 – Effective January 1, 2006: Carriers, DMERCs, and FIs will accept an NPI along with a Medicare legacy identifier, but the legacy identifier will still be used in claims processing.
Stage 2 – Effective October 2, 2006 through May 22, 2007: Carriers, DMERCs, and FIs will accept an NPI along with a Medicare legacy identifier. If an NPI is passed, it will be used in the Medicare Crosswalk for claims processing.
Stage 3 – Effective May 23, 2007 and later: Carriers, DMERCs, and FIs will require an NPI. Medicare legacy identifiers should not be used.
Stage 4 – Effective May 23, 2007 through May 22, 2008: Carriers, DMERCs, and FIs will transmit Coordination of Benefits (COB) claims to small trading partners with NPI only. 

To accommodate the NPI transition, a revised CMS-1500  has been announced by the National Uniform Claim Committee (see CMS CR 4293 and www.NUCC.org). Payers should accept the revised form starting October 1, 2006. For institutional billing, a new form, UB-04,  has been announced by National Uniform Billing Committee (see www.NUBC.org). Payers should accept this form starting March 1, 2007.

The HARP NPI implementation strategy targets Stage 2 to begin storing and passing/printing NPIs by October 2, 2006. Prior to that date, the HARP development staff will be creating fields within HARP for NPIs, revising our electronic claim output format, and updating the claim print program for the revised CMS-1500.  The HARP UB-04 claim print program will be completed in early 2007, in time for the scheduled replacement of the UB-92 between March and May 2007.

We ask that you please wait to enter Provider NPIs into HARP.  We will let you know when HARP is ready for NPIs to be added via HARP Release Notes. At that time, we will also be collecting NPIs for providers billing electronically so our EDI department may update their files.