Agencies
Services
Provider Notice issued 05/14/07
National Provider Identifier (NPI) Implementation Contingency Plan
| To: | All Enrolled Providers |
| Date: | May 14, 2007 |
| Re: | National Provider Identifier (NPI) Implementation Contingency Plan |
The Illinois Department of Healthcare and Family Services (HFS) is pleased to announce a contingency plan for covered entities who are unable to meet the May 23, 2007, deadline for compliance with the NPI regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This announcement follows the federal Centers for Medicare and Medicaid Services, Department of Health and Human Services (DHHS) contingency plan for NPI, which was released on April 2, 2007.
The DHHS contingency plan allows an additional 12 months from the May 23, 2007, implementation date. The HFS contingency plan will periodically be assessed to determine when to enforce the NPI requirements. HFS will likely begin to phase in, by provider type, the requirement of the NPI in the next few months. HFS will provide advanced notification to the providers of the effective date when claims will begin to reject. HFS will require the NPI for the “Billing Provider” only.
The following are the guidelines of how HFS will operate under their NPI Contingency Plan, which is effective with claims received on or after May 23, 2007:
Claim submitted with NPI only
HFS will attempt to crosswalk the NPI to an HFS legacy provider number. If the crosswalk is successful, process the claim. If the crosswalk is not successful, the claim cannot be processed.
Claim submitted with NPI and HFS Legacy Provider Number
HFS will attempt to crosswalk the NPI to an HFS legacy provider number. If the crosswalk is successful, process the claim. If the crosswalk is not successful, use the HFS legacy provider number to process the claim.
Claim submitted with an HFS Provider Number Only
HFS will use the HFS legacy provider number to process the claim.
Electronic Transactions and Paper Billing Forms
The following chart identifies by claim type which identifier (NPI or HFS Legacy Provider Number) HFS will accept.
| Transaction Type | NPI | HFS Legacy Provider Number | NPI & HFS Provider Number |
|---|---|---|---|
Institutional 837 |
Yes |
Yes |
Yes |
Professional 837 |
Yes |
Yes |
Yes |
MEDI/IEC Direct Data Entry (DDE) |
Yes |
Yes |
Yes |
NCPDP |
Yes |
Yes |
No |
Paper Billing Forms |
Yes |
Yes |
No |
UB92 Paper Billing Forms |
No |
Yes |
No |
HFS encourages providers that have not yet obtained NPIs to do so immediately. To apply for an NPI, visit the National Plan/Provider Enumeration System (NPPES) Web site at https://nppes.cms.hhs.gov/
Providers who have not reported their NPI information to HFS should do so immediately. Please reference the following MEDI Web site to report your NPI information www.myhfs.illinois.gov or there is now a Web-based application available to report NPI information www.illinoisnpi.com
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.
HFS is not ready to accept or process the NPI for the following HIPAA transactions:
270/271 Eligibility Inquiry/Response
276/277 Claim Status Inquiry/Response
278 Prior Approval
The HFS legacy provider number is required, until further notification from HFS, for these transactions.
If you have any questions regarding this notice, please contact the Bureau of Comprehensive Health Services toll-free at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs