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Who's Ready For Provider IDs?
March 2007
Payer and provider organizations just now starting efforts to comply with the National Provider Identifier rule likely won't be ready by the May 23 deadline, according to the Centers for Medicare and Medicaid services. CMS estimates it takes an average of 120 days for a provider organization to complete all the necessary steps for compliance.
The NPI is the second of the Health Insurance Portability and Accountability Act standard identifier rules to go into effect. It was issued by the Department of Health and Human Services in January 2004. The effective date of the rule was May 23, 2005, with compliance required within two years. CMS, an HHS department, enforces most the HIPAA administrative simplification rules.
The NPI rule mandates that payer and provider organizations use a designated 10-digit numeric provider identifier for most administrative and financial transactions. National provider identifiers, along with the other standard HIPAA identifiers, are designed to reduce costs and simplify processes associated with the use of multiple, conflicting IDs. CMS since last fall has accepted Medicare and National Council for Prescription Drug Programs transactions using NPIs instead of legacy identifiers.
But preparations for using a single, standard identifier for each of the nearly 2.3 million individual and organizational providers in the United States have proven to be anything but simple. Before using the new identifiers, payers and providers must work together to exchange the IDs, verify system and administrative readiness to accept and process them, and perform test transactions.
These collaborative requirements have been a challenge for many industry stakeholders. Additionally, some industry observers say delayed instructions from the Department of Health and Human Services detailing the NPI bulk enumeration and data dissemination processes also have been compliance obstacles.
The Workgroup for Electronic Data Interchange, an industry advisory group, has monitored compliance progress and last December asked CMS to establish a contingency plan that allows for the use of legacy identifiers for 12 months after the industry has access to the agency's data dissemination database. Access to the National Plan/Provider Enumeration System database would enable organizations to retrieve the identifiers of all the physicians with which they do business. But as of early February, CMS had not yet provided access to stakeholders.
Additionally, the National Committee on Vital and Health Statistics, another government advisory body, in November recommended CMS open access to the database.
The committee held meetings in late January to hear testimony about industry readiness to comply with the NPI rule. As a result of the testimony, NCVHS planned to recommend that if a contingency plan or transition period is devised, it should be permitted only for the final transactions testing phase of compliance. Further, any contingency plan should enable transactions with NPIs or dual identifiers to be tested for a six-month period after May 23, or six months after access to the NPPES database was granted.
Unlikely compliance
While Reston, Va.-based WEDI, payers and other industry groups have conducted NPI educational outreach programs, recommendations were issued to CMS because many covered entities aren't likely to be ready to comply by May 23, says Richard Landen, director of health information technology at the Blue Cross Blue Shield Association, Chicago. Landen also is a director at WEDI.
"In order to successfully implement the NPI, it will take a lot of collaboration between providers and payers," he says. "At this late date, we're worried there's not the time to get that established by May 23."
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