National Provider Identification
Attention Participating Providers and Trading Partners
All MVP participating providers are required to report their NPIs to MVP before May 23, 2008 regardless if they submit claims electronically or on paper. MVP's CMS NPI contingency plan will end May 23, 2008. After that date, all HIPAA-mandated electronic (EDI) and online transmissions must contain NPI only. MVP is currently accepting NPI-only claim submissions - there is no need to wait until May 23, 2008. Providers should visit the Provider Home Page on MVP's website to report their NPIs. MVP will not be able to process EDI or online claims without providers? NPIs after May 23, 2008.
MVP Announces NPI Contingency Plan
As a health plan, MVP achieved compliance with the HIPAA NPI mandate by the required May 23, 2007 effective date; however, some participating providers and facilities have not yet obtained and/or reported an NPI to MVP. To avoid a disruption in claims processing and reimbursement, MVP will use a contingency plan authorized by the Centers for Medicare & Medicaid Services (CMS).
MVP is extending the CMS dual strategy approach adopted in 2006. Until further notice, providers and facilities may continue to submit both an MVP provider ID (legacy) number and NPI number on all HIPAA covered transactions, including claims submitted electronically.
Important NPI Clarification
The CMS 1500 format is used by providers for electronic and paper claims submission. Regardless of submission mode, completion of the form should follow the National Uniform Claim Committee standards. MVP suggests that all providers follow the standard that states:
- The individual Rendering Provider's NPI is placed in box 24J
- The Billing Provider's (owner of the tax ID in box 25) NPI is placed in box 33A
MVP also recommends that, when known, the NPI of the referring provider be used in box 17B and the NPI of the service facility location be placed in box 32A. The use of the rendering provider's Taxonomy number is also recommended in box 24J. If you have any further questions on the use of the NPI, please contact your Professional Relations representative.
MVP required all participating providers and facilities to obtain and report an NPI to the plan by May 23, 2007. Apply for your NPI or report your NPI to MVP Health Care. Please note: VMC providers only should obtain and report an NPI directly to VMC via e-mail: email@example.com, fax: (802) 847-6214, or telephone: (802) 847-8161.
Your NPI must be reported to MVP prior to submitting claims with your NPI. If you have already reported your NPI number to MVP, please validate your NPI on the MVP website prior to submitting claims.
MVP will continue testing all covered transactions to ensure accurate processing of claims and information (e.g., referrals, member eligibility, remittances).
Providers and facilities may review MVP's online NPI Questions and Answers for additional information about this contingency plan. Vendors and clearinghouses may call MVP's EDI coordinators directly at 1-877-461-4911. View a PDF of the Guidance on Compliance with the HIPAA NPI Rule.
NPI: Get It. Share It. Use It.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the adoption of a standard unique identifier for health care providers. Effective May 23, 2007, all HIPAA electronic standard transactions are required to use the National Provider Identification (NPI) number as the sole provider identifier.
The NPI is a 10-digit, intelligence free numeric identifier. Intelligence free means that the numbers do not carry information about health care providers ? such as provider type or specialization. Health care providers will no longer need to maintain separate proprietary provider numbers for each health insurance company. The NPI will replace provider identifiers in use today in all standard electronic transactions. Those numbers include Medicare legacy IDs (UPIN, OSCAR, PIN and National Supplier Clearinghouse).
NPI numbers can be obtained for individual practitioners and health care organizations (group practices and facilities). Each practitioner (physician, adjunct, mid-level) can obtain one NPI number. Health care organizations can obtain multiple NPI numbers to represent the different sub-parts of the organization.
The Centers for Medicare and Medicaid (CMS) has been designated to act as the NPI enumerator for all practitioners and organizations in the United States. To be issued an NPI number, providers must complete an application (either online or on paper).
Professional and facility paper claim forms are being modified by regulatory agencies to allow NPI numbers.
Please review MVP's list of NPI Questions and Answers for additional information.