February 2008 Newsletter

NPIs for Referrals

By: TechComm Services Manager

Another deadline in the NPI implementation plan is looming this spring. As of May 23, 2008, CMS will not pay for referred or ordered services unless the referring/ordering providers are identified on claims by NPI and name. It is the responsibility of the billing provider to obtain NPIs from their referring and ordering physicians prior to delivering services.

In anticipation of the burden caused by this requirement, CMS recently issued a transmittal with a temporary solution for service providers who have difficulty obtaining a referral’s NPI. If multiple attempts to obtain an NPI from a reluctant referral are unsuccessful, service providers are permitted to use their own NPI and name in the ordering/ referring/ attending/ operating/ other service facility provider/ purchased service provider fields.

The requirements pertain to both Medicare Part A and Part B claims. For further information on this topic, see MLN Matters Number MM5890.

Referral NPIs in HARP

In order to avoid claim denials or delays in claim processing, we recommend that you make it a priority to obtain NPIs from your referrals and populate them in HARP as soon as possible. Some insurers may require NPIs for referrals well before the May 23 CMS deadline. Texas Medicaid, for example, will accept only NPIs as referral identifiers as of March 2008.

NPIs for referrals are stored in HARP as provider numbers in the NPI referral category. Individual NPIs can be added manually, but the easiest way to add a large volume of NPIs to HARP is to load them from a spreadsheet. The spreadsheet format should be:

Column 1 – Referral code
Column 2 – NPI
Column 3 – Referral name

The Quadax Application and Technical Support departments are ready to assist you with loading your referral NPIs into HARP. Contact your Quadax Service Consultant for further information or questions.