May 2008 Newsletter

Suppressing Legacy Provider Numbers

By: Candace Wintering, TechComm Services Manager, and Tom Klemens, Manager EDI Edits & Documentation Group

May 23, 2008 is the next significant date in the NPI implementation plan. As of this date, Medicare, along with many other payers, will begin to accept only NPIs as provider identifiers and to reject claims that include legacy numbers. Quadax has been monitoring payer policies on legacy provider numbers and updating our systems for this requirement.

HARP Claims

Most providers have both NPIs and legacy provider numbers stored in HARP. When payers no longer accept legacy numbers, it will not be necessary to remove them from HARP. In fact, we prefer that HARP retain the legacy numbers just in case payers experience difficulties with NPI only and revert to dual numbers. Instead, we have developed strategies for suppressing legacy numbers on claims, with a different approach for electronic and hardcopy claims.

Electronic claims from HARP

Quadax is managing the suppression of legacy numbers on electronic claims from HARP on a payer-by-payer basis. Our claim editing process for electronic physician and institutional claims will prevent legacy numbers from being included once we verify that a payer no longer accepts them. The suppression edits are based on claim type. Since we realize that payers often change requirements with little notice, controlling suppression at the claim edit level allows us to quickly make updates for all clients.

Gateways, such as Emdeon and THIN, are instituting their own edits to suppress legacy provider numbers. Quadax will not create edits to suppress legacy numbers for claims sent through gateways.

Hardcopy claims from HARP

The suppression of legacy provider numbers on hardcopy claims is controlled by an insurance category parameter in HARP. To activate it, simply enter the date in the suppress legacy provider numbers field, and legacy numbers wll not print on hardcopy claims after that date. The HARP Support staff have added the May 23rd date for Medicare insurance categories for all Manager and Partner clients; if legacy numbers should be suppressed for other payers, Manager and Partner clients should contact their application support service representatives and request an update to the parameters. Standalone clients should add this date themselves for Medicare and any other insurance categories that will no longer accept legacy numbers. Clients should monitor their hardcopy claim rejections after May 23, 2008 to determine if updates are necessary for other payers. See Insurance Category Parameters in the HARP Maintenance Manual for details on the legacy number suppression parameter.

Referral NPIs

May 23rd is also the date that NPIs will be required for referrals on claims to Medicare and many other payers. Be sure that all your referring providers have an NPI stored in HARP before that date.

Xpeditor Electronic Claims

Quadax is taking a slightly different approach to managing the implementation of NPI only for our Xpeditor clients. Instead of suppressing the legacy number from the outgoing 837 file, a NOTE edit ("WARNING - Legacy # Should be Blank - 05/23/08") has been created for both UB and 1500 claims to indicate that the legacy physician numbers should no longer be used. The edit will be implemented with the May 6th codetable update. Effective with the May 20th codetable update, the NOTE edit will be replaced by the "standard" Xpeditor edit "Legacy Provider Number Must be Blank" to ensure that legacy numbers are not present on certain claims on or after 05/23/08. However, if a legacy number is provided, it will be validated.

Like our HARP counterpart, these edits will be applied on a payer-by-payer basis. Currently, these edits will be applied to the following payers:

• All Medicares
• Aetna
• Blue Crosses: Alabama, Anthem, Kentucky, North Carolina, Texas
• Medicaids: California, Georgia, Iowa, Illinois, Indiana, Pennsylvania, Texas
• Medical Mutual of Ohio

Other payers will be added as their final NPI policies are published.

Also similar to HARP, Quadax EDI will not apply these edits to claims sent through gateways such as Emdeon and THIN.