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NPI Reminder
January 29, 2007

The deadline for obtaining a National Provider Identifier (NPI) is rapidly approaching. The NPI replaces provider identification numbers for Health Insurance Portability and Accountability Act (HIPAA) transactions. Feedback received from Highmark Medicare Services indicates that behavioral health providers in Pennsylvania are doing well with obtaining an NPI. However, the feedback from the Office of Medical Assistance Programs (OMAP) is that 98 percent of active service locations for health care providers are currently unregistered. PCPA has requested information specifically about behavioral health providers and will report to members as this information becomes available. Regardless, it is imperative that providers obtain an NPI and are able to use it by the federally mandated deadline of May 23. OMAP has a web page that provides information and links related to NPI (www.dpw.state.pa.us/Business/NPIinfo). Included is a Medical Assistance bulletin, Instructions for Registering Your National Provider Identifier (NPI) Number to the Department of Public Welfare (DPW), a question and answer document, Provider Quick Tips, and registration information. In preparation for transition to the use of NPI, DPW requests that all providers register their NPI information no later than mid-April. Information must be registered and validated by DPW staff before claims can be submitted using the NPI.

DPW has requested that provider associations recruit providers who are willing to test their NPI. Providers who are interested in testing must meet the following criteria:

  • Must have their NPI numbers registered with DPW,
  • Must bill electronically using the HIPAA 837 Standard transaction, and
  • Should actively use and receive an 835 Remittance Advice from the PROMISe system.

Interested providers must submit a request to participate in testing to mahart@state.pa.us no later than February 16. The following information must be included: organization name, contact person name, contact phone number, and PROMISe MAID.

Additional information is available on the Centers for Medicare and Medicaid Services web site (www.cms.hhs.gov/NationalProvIdentStand) and in a new MLN Matters article (www.cms.hhs.gov/MLNMattersArticles/downloads/SE0679.pdf). Please contact Betty Simmonds with questions.

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