National Provider Identifier (NPI) Update

On April 2, 2007, the Centers for Medicare and Medicaid (CMS) published guidance to the healthcare industry regarding National Provider Identifier (NPI) contingency planning. CMS’ NPI contingency plan guidance allows providers, vendors, clearinghouses and health plans (‘covered entities’) that demonstrate "good faith efforts" a maximum of 12 additional months (i.e., May 23, 2008) to achieve NPI compliance without financial penalty. 

CMS encouraged ‘covered entities’ to assess the readiness of their communities and determine the need to implement contingency plans to maintain the flow of payments, while continuing to work toward compliance.

TRICARE, like the majority of other payors, will not deny claims for failure to include the provider’s NPI on the HIPAA-standard electronic transaction before the compliance date. However, to facilitate the use of NPIs as a routine practice for the submission of HIPAA transactions, providers are strongly encouraged to use their NPIs as their primary provider identifier as soon as possible.

TriWest is committed to supporting our provider community in the successful implementation of NPI on or before the compliance date of May 23, 2008. We recognize that the implementation of NPI can present both administrative and technical hurdles that could disrupt the flow of payments. Check out these NPI tips to help overcome some of these hurdles:

Get It

Obtain your NPIs from the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/NPPES/Welcome.do for electronic issuance or to obtain a copy of the paper application.

Share It

Share your NPIs (both individual and corporate) with all your payors, including your area’s inpatient/outpatient facilities, other physicians that you deal with regularly and pharmacies. Go to www.triwest.com/Provider Connection/Your NPI Connection to learn how to share your NPI with TriWest.

Use It

Use your NPIs in all standard electronic transactions. If you need more information on how to use your NPI in a TriWest transaction, or you would like to send test transactions, contact our EDI consultants at (1-800)782-2680.

Check It

Check with your practice management system vendor and your clearinghouse or billing service to determine if they are NPI ready.

If you have any questions regarding NPI for TRICARE, please contact our EDI consultants at (800) 782-2680.