February 2007 Newsletter

HARP Positioned for Change:
NPI-Revised CMS-1500 and UB-04

By: VP Implementation and Support, A/R Services

2007 promises to be a very interesting year.  A year of change, that’s for sure!

The magic date is May 23, 2007.  This is when the National Provider Identifier (NPI) will be required on electronic transactions for HIPAA-covered entities. Although this mandate is meant to “simplify” healthcare transactions, getting there is not necessarily that simple and certainly requires effort.

HARP and Quadax EDI have been busy making the changes necessary to comply. Electronic transactions for many payers have already started including dual provider numbers—legacy and NPI. HARP users and Quadax Service Consultants have been working together gathering NPIs and legacy qualifiers and populating them into HARP. 

The next step in this transition is to begin including NPIs on hardcopy claims. Two new claim forms are necessary to implement NPI—the revised CMS-1500 (08-05) for professional services and the UB-04 for institutional. These new forms provide fields for both legacy provider numbers and NPIs. Also, a qualifier field associated with legacy provider numbers is required during the transition period that indicates the type of number (license number, Social Security Number, UPIN, etc.) printed. Several other fields have been moved, changed, or removed.  

We have been monitoring payer announcements regarding their readiness to accept the NPI, along with the new CMS-1500 and UB-04. Those announcements have been mixed. Many payers are already able to process transactions with NPIs and claims on the revised CMS-1500. However, others are asking providers to wait.

The Centers for Medicare & Medicaid Services (CMS) issued the following timeline for these new forms in CMS CR 5060 dated Sept. 15, 2006 and CMS CR 5072 dated Nov. 3, 2006.

CMS-1500 timeline:

• Jan. 2, 2007: Health plans, clearinghouses, and other information support vendors shall be ready to handle and accept the revised Form CMS-1500 (08-05).
• Jan. 2 – March 30, 2007: Providers can use either the current Form CMS-1500 (12-90) version or the revised Form CMS-1500 (08-05) version.
• April 2, 2007: The current version of the claim form, Form CMS-1500 (12-90), is discontinued; only the revised Form CMS-1500 (08-05) is to be used. All rebilling of claims should use the revised Form CMS-1500 (08-05) from this date forward, even though earlier submissions may have been on the current Form CMS-1500 (12-90).

A HARP software release that contains the new CMS-1500 form is planned for late February 2007. Software changes include new templates, field options, and printing programs. The release was postponed from January as some payers have indicated they were not ready to accept the new form. This release of HARP will include the ability, on a payer by payer basis, to select the old CMS-1500 form as well as the new form.

UB-04 timeline:

• March 1, 2007: Health plans, clearinghouses, and other information support vendors shall be ready to handle and accept the UB-04 (CMS-1450).
• March 1 – May 22, 2007: Institutional claim filers can use either the current UB-92 or UB-04.
• May 23, 2007: All institutional paper claims must be submitted on the UB-04.  The UB-92 will no longer be acceptable, even as an adjustment claim, after May 22, 2007. All rebilling of claims should use the UB-04 from this date forward, even though earlier submissions may have been on the UB-92.

A HARP software release that includes the new UB-04 form is planned for April 2007. In addition to the new form, templates, and field options in this release, HARP will no longer use Insurance company name to determine electronic claim routing. A new field by Insurance Company will store the appropriate Quadax payer code.

What should HARP clients be doing to prepare? 

• Providers should obtain their own NPIs and the NPIs for any providers that refer patients to them.
• Billing Services should gather NPIs from providers they bill for and the NPIs for referring/ordering providers as well.
• Share your NPIs with the payers you are currently registered with.
• Work with your Quadax Service Consultant to populate NPIs in HARP and the Quick EDI system.
• Work with your Quadax Service Consultant to populate legacy qualifiers (see Provider Numbers Screens in the minor enhancements for HARP 2.28c release notes for details).
• Work with your Quadax Service Consultant to populate taxonomy codes (institutional providers only).
• Obtain new CMS-1500 forms and/or UB-04 forms.