Provider Notice issued 12/13/06

National Provider Identifier (NPI) Implementation

In an Informational Notice dated April 21, 2006, the department encouraged providers to begin the process of obtaining their NPIs.  All health care providers, as defined in 45 CFR 160.103, are eligible to obtain an NPI.  Entities that do not provide health care (e.g., non-emergency transportation services) are not required to obtain a NPI because they do not meet the definition of “health care provider.”  To ensure that providers do not experience claim denials or delays in claims processing or reimbursement, the department encourages enrolled providers to report their NPI information as soon as possible.

Reporting of NPIs

Healthcare & Family Services (HFS) will require the NPI on all electronic, direct data entry, and hard copy claim submittals with the exception of the UB92 Claim Form beginning with claims received on or after May 23, 2007.  The department will reject all claims received without an NPI on or after May 23, 2007.  Prior to the May 23rd mandatory requirement of submitting NPIs on all claims, providers must report their NPI to the department.  To assist providers the department will offer three methods for reporting NPIs:

• The Medical Electronic Data Interchange (MEDI)/Internet Electronic Claims (IEC) are Internet applications for enrolled providers and provider payees to electronically submit and receive information from the department.  The MEDI system will be used to collect NPI numbers from users.  This will be done through a new screen for entering NPI numbers for all provider and payee registrations.  Only the Administrator will have the ability to enter NPI information for providers and payees.  Please reference the following Web site http://www.myhfs.illinois.gov/ to begin your NPI reporting.  Once the Administrator has logged into the MEDI system, NPI instructions will be provided on the MEDI Home Page.

• For providers who do not have access to the Internet, there is a paper NPI Enrollment Process.  You may contact the Provider Participation Unit at (217) 782-0538 to request a NPI Enrollment packet.  The paper form will also include information about the provider’s payees.

• There is now a Web-based application available through which an enrolled provider will be able to report their NPI information to the appropriate Illinois social service agencies.  This interface will allow the provider to communicate their NPI(s) to multiple agencies, in addition to the provider’s current agency specific identification number.  

Verification letters reflecting the NPI information captured in the department’s system will be sent to providers and payees.  The verification letter should be reviewed and problems with the NPI information should be reported to the department’s Provider Participation Unit by calling  (217) 782-0538.  For providers who are part of a corporate structure, please ensure that your NPI verification letter is forwarded to the appropriate area in your organization.

Claim Submittal

837 Professional Electronic Transactions:  Even though the NPI will not be required for claims processing until May 23, 2007, physicians and non-institutional providers can currently submit both the NPI and the legacy provider number in 837 transactions.  Effective with claims received on or after May 23, 2007, the NPI must be reported in the 837 submission.

NCPDP (Electronic Pharmacy) Transactions:  Claims must contain only the legacy provider number on claim submittals received through May 22, 2007.  Effective with claims received on or after May 23, 2007, the NPI must be reported.

Direct Data Entry (DDE):  All DDE submittals must conform to the requirements as defined for NCPDP above.

Paper Invoices:  Since there is only one field for the Provider Identification Number on paper claims, paper claim forms will not accommodate both the legacy provider number and the NPI.  Therefore, claims must continue to contain only the legacy provider number on submissions received through May 22, 2007.  Effective with claims received on or after May 23, 2007, the NPI must be reported on the paper claim forms with the exception of the UB92 Claim Form.  The NPI will be entered in the same field on the paper claim form as the legacy provider number.

Effective with all claims received on or after May 23, 2007, if the NPI received on the claim does not match the information contained in the department’s NPI database, the department will generate a report back to the submitter, identifying the unknown NPI.  The claim will have to be resubmitted to the department with the correct NPI.

Effective with claim submissions on or after May 23, 2007, the department’s paper Remittance Advice (HFS 194-M-1) will display both the NPI and the HFS legacy provider number.

Your participation in our program is greatly appreciated.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs