Provider Notice issued 04/11/08

National Provider Identifier (NPI) Implementation

The purpose of this notice is to inform providers that Healthcare and Family Services (HFS) will require the Billing Provider's NPI on all electronic, direct data entry, and hard copy claim submittals beginning with claims received on or after May 23, 2008. If the Billing Provider's NPI is not reported, the department will reject the claim. Providers must ensure that they have registered their NPI information with HFS prior to claim submittals.

NPIs for Other Physician IDs, such as, Prescribing, Attending, Operating, and Other will be required beginning with claims received on or after July 1, 2008.

In the near future, HFS will begin requiring that the NPI be reported to designate the Pay-To Provider (Payee), which will replace our current requirement of reporting the 1-digit payee code to designate the appropriate pay-to provider (payee). Until that time, providers must continue to report the one-digit payee code to designate their appropriate payee when submitting claims to HFS. Reporting of the NPI for the Pay-To Providers, instead of the one-digit payee code, will cause the claim to reject.

The Billing Provider's NPI should be reported as indicated below:

837 Institutional & 837 Professional Electronic Transactions

The NPI must be reported in Loop 2010AA, Billing Provider.

Direct Data Entry (DDE)

The NPI must be reported in the NPI field on the Provider Tab. If you have registered your NPI with HFS, it will appear in the dropdown list.

Paper Claim Forms

The NPI must be reported in the same field on the paper claim form as the legacy provider number, with the exception of the UB04, which does have a designated NPI field. HFS will require that the HFS Legacy Provider Number continue to be reported on Paper Adjustment Forms & Paper Prior Approval Forms

In addition to the above, HFS is ready to accept or process the NPI for the following HIPAA transactions

• 270/271 Eligibility Inquiry/Response

• 276/277 Claim Status Inquiry/Response

At this time, HFS will not be reporting the NPI information back to the providers in the other HIPAA transactions or the paper remittance advices.

CMS has announced that for Medicare Crossover Claims that are processed through the Coordination of Benefits Contractor (COBC), the Medicare Legacy Number will not be reported in the 837P to IL Medicaid on or after the 5/23/08 NPI implementation date. As a result of this decision by CMS, it is critical that providers report their NPI information to HFS, prior to billing their Medicare Crossover Claims.

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, you may fax the proper documentation to the Provider Participation Unit at 217-557-8800.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa Eagleson, Administrator

Division of Medical Programs