HIPAA NPI Contingency Plans
February 13, 2008
Health plans and payers are beginning to report the end dates of
their NPI Claims Contingency Plans. Medicare has announced that
effective March 1, Medicare fee-for-service claims must include an NPI
in the primary provider fields (i.e., the billing, pay-to provider and
rendering provider fields) or they will be rejected. Additionally,
many of the major health plans in Massachusetts have announced that
their contingency plans will end as of May 23, 2008. Tufts Health
Plan has already moved to accepting NPI only claims and other
transaction submissions. See the chart below for more
information.
Health Plan Implementation Dates for Claim
Submissions (as of January, 2008)
|
Health Plan
|
Health Plan
Executing Contingency
|
Health Plan Contingency
End Date |
Plan Claim Form Requirement with Form
Rejection
|
|
Medicare
|
Yes
|
3/1/ 2008
- Medicare FFS 837P and CMS-1500 claims must include NPI in primary
claim fields, failure to submit NPI in primary fields will result in
claim reject
- NPI only or NPI/legacy pairs can still be submitted in correct
fields
- Claims with both NPI and Medicare legacy #s rejected if the pair is
not found on the Medicare NPI Crosswalk
- Claims with only Medicare legacy in primary field rejected
5/23/2008
- CMS will lift NPI contingency plan, and only accept NPI sent on all
HIPAA electronic transaction (837I, 837P, NCPDP, 276/277, 270/271, and
835), paper claims and SPR remittance advice
- CMS will stop sending legacy identifiers on COB crossover
claims.
|
1/1/2008
-
837I electronic claims and UB-04 paper claims without
an NPI in fields identifying the primary provider rejected
-
Legacy identifiers paired with NPIs (in primary
provider fields) accepted in secondary provider fields
|
|
Blue Cross Blue Shield of MA
|
Yes
|
3/1/ 2008
- Dual-use claims (with NPI & Legacy#) accepted until 5/23
|
No longer accept UB 92 claim forms. Still accepting
older versions of CMS-1500 form & dental claim forms.
|
| BMC HealthNet |
Yes
|
5/23/ 2008
|
Currently accepting new & old
forms. No plans to reject claims submitted on old forms between now
& 5/23/08 |
| Beacon Health Strategies |
Yes
|
5/23/ 2008
|
Currently accepting new & old
forms. |
|
Fallon Community Health Plan
|
Yes
|
5/23/ 2008
|
Currently accepting both forms.
Providers can use the old forms until their supplies are exhausted. |
|
Harvard Pilgrim Health Care
|
Yes
|
5/23/ 2008
|
No longer accept UB-92 claim forms or CMS -1500 forms
prior to “(rev. 08-05)”, or older versions of the dental
claim forms.
|
|
Health New England
|
Yes
|
5/23/ 2008
|
Currently accepting new & old forms. No plans to
reject claims submitted on old forms between now & 5/23/08
|
|
Mass Health
|
Yes
|
5/23/ 2008
|
No longer accepts UB-92 claim forms. Accepting
current version of proprietary forms, CMS 1500 and UB04; note crossover
claims are accepted on 1500, as they always have been for professional
billing
|
|
Neighborhod Health Plan
|
Yes
|
5/23/ 2008
|
Currently accepting new & old
forms. No plans to reject claims submitted on old forms between now
& 5/23/08 |
| Network Health |
Yes
|
5/23/ 2008
|
Currently accepting new & old
forms. No plans to reject claims submitted on old forms between now
& 5/23/08 |
|
Tufts Health Plan
|
No --
However, will accept legacy ID as secondary identifier
|
5/23/2007
5/23/2008
- Legacy ID will only be accepted as a secondary identifier until
5/23/08.
|
Currently accepting both old and new claim forms.
|
(Chart Source: Massachusetts Health Data Consortium
NPI Advisory #13, January 2008.
Available at http://www.mahealthdata.org/hipaa/resources/identifiers/20080131_NPIAdvisory_13.pdf)
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