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17 Weeks Until NPI-Only Claims Required
January 25, 2008

An Office of Medical Assistance Programs (OMAP) briefing on the National Provider Identifier (NPI) was provided during the January Medical Assistance Advisory Committee meeting. Attendees were reminded that only 17 weeks remain until only the NPI will be accepted on Medical Assistance claims. OMAP has experienced an increase in the rate of NPI registrations following distribution of reminder letters in late 2007. However, many providers must still register NPIs with OMAP. For the week of January 14, OMAP statistics indicate that of 90,742 claims, 45 percent submitted using the legacy number only, 54 percent used both the NPI and legacy number, and one percent used the NPI only. Of 40,433 claims that were submitted using only the legacy number, 59 percent must have an NPI or will be denied as of May 23. Forty-one percent of these claims were atypical providers and are permitted to continue to use the legacy number. Of the 48,948 claims that were submitted using both the NPI and legacy identifiers, 37,467 were submitted correctly, 24 percent triggered errors in which either the legacy number did not match or there was no NPI on file. OMAP Provider Enrollment staff are contacting providers whose legacy number does not match the one on file to correct the discrepancy. A Remittance Advice Alert (RA) will be used to notify those whose NPI is not on file.

OMAP is developing teleconference training for electronic billing providers and billing vendors that will be offered in March, April, and May. An RA will be issued in February, March, and April announcing the training classes and providing registration information. Provider training will emphasize the importance of combining the correct NPI, taxonomy, and zip code on the claim transaction. Provider response guidelines are being developed to assist providers when claims deny.

NPI information is available on the Department of Public Welfare web page (www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/DoingBusiness/NPIinfo).

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