RCPA - Rehabilitation and Community Providers Association


NPI Needed May 23
March 28, 2008

At a recent Medical Assistance Advisory Committee (MAAC) meeting, the Office of Medical Assistance Programs (OMAP) strongly encouraged providers that have registered National Provider Identifiers (NPIs) with the Department of Public Welfare (DPW) to use the NPI now for claims submission. Testing before the May 23 deadline will minimize the risk of denials, payment delays, and losses. Providers that have not yet obtained or registered NPIs for active service locations must do so as soon as possible. Atypical providers are not required to obtain an NPI (www.dpw.state.pa.us/Resources/Documents/Pdf/AtypicalProvTypesAndSpecialties.pdf). According to statistics for March 10 based upon electronic claims submitted, the percentage of clinics (Provider Type 08) with registered NPIs was 81.16 percent and that of mental health/substance abuse providers (Provider Type 11) was 85.62 percent. Registrations are improving, but more must be done. Providers that have an NPI but currently use the legacy identifier receive edit 1150 on the remittance advice/835 that indicates that the legacy identifier was used. The edit is set to pay now, but on May 23 it will deny payment. The NPI, taxonomy, and nine digit zip code are needed to identify the correct provider and service location. Providers can use the Electronic Provider Enrollment Automation Project (ePEAP) at http://promise.dpw.state.pa.us to check information on service locations, but cannot make changes. These must be done through the Provider Service Center at 800-537-8862.

OMAP has openings remaining for conference call training for electronic billers on NPI on April 2 and May 6 at 1:00 p.m. and recommends that providers register as soon as possible. Only 100 telephone lines are available for each session. Register for the call on the PA PROMISe Provider Conference Call Training web site (www.dpw.state.pa.us/omap/promise/provconfcalltrng_process.asp). OMAP plans to make the teleconference presentation materials along with questions and answers from the training sessions available at www.dpw.state.pa.us/omap/promise/provconfcalltrng_Q&Aresponses.asp.

In mid-April the OMAP Provider Inquiry unit will verify that each provider that contacts the inquiry line has an NPI that is registered with DPW. A new recorded message on the provider inquiry line in mid-April will urge callers to register NPIs and will count down the days to May 23 implementation. The provider inquiry line should be able to manage a higher volume of calls if needed following implementation. OMAP will compile daily reports to identify NPI issues leading to increased call volume and will make the information available, as needed. Please contact Betty Simmonds with questions.

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