Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth All Provider Bulletin 164 May 2007 TO: All Providers Participating in MassHealth FROM: Tom Dehner, Acting Medicaid Director RE: Implementation of National Provider Identifier (NPI) Number Background This bulletin explains: * MassHealth’s implementation plan for NPI; * changes to the claim-submission process for paper claim forms and electronic transactions; and * MassHealth’s contingency plan as a result of the clarifying guidance from the Centers for Medicare & Medicaid Services (CMS) on NPI dated April 2, 2007. National Provider The Administrative Simplification requirement of the Health Insurance Identifier (NPI) Portability and Accountability Act (HIPAA) mandates that health-care providers acquire and use a national provider identifier (NPI), effective May 23, 2007. The NPI is a unique 10-digit number used to identify health-care providers for billing purposes in all HIPAA electronic transactions. Effective May 23, 2007, for applicable provider types (see below for exemptions), all paper and electronic claims submitted to MassHealth must contain an NPI. MassHealth does not issue NPIs. For more information about applying for an NPI, visit the CMS Web site at http://www.cms.hhs.gov. You may apply at https://nppes.cms.hhs.gov/NPPES/. Exemptions MassHealth has determined that nonemergency transportation and rest homes do not meet the definition of a health-care provider, as outlined in the NPI Final Rule, and therefore are not required to obtain an NPI for MassHealth billing purposes. (continued on next page) Pharmacy, Municipal Pharmacy and municipal Medicaid providers are required to acquire Medicaid, and Dental and use an NPI for claims effective May 23, 2007. Providers Pharmacy providers do not need to report their pharmacy NPI to MassHealth or ACS directly. NCPDP will provide ACS (POPS) with the pharmacy providers' NPIs. A recent Pharmacy Facts (Number 27, April 20, 2007) provided further clarification. Pharmacy providers must report any other applicable NPIs directly to MassHealth, including NPIs for durable medical equipment, oxygen and respiratory therapy equipment, orthotics, and prosthetics. Municipal Medicaid providers should report their NPI to UMass at 508-856-8631 or schoolbasedclaiming@umassmed.edu. (UMass will collect your NPI and provide it to MassHealth.) Dental providers should contact Doral at 1-800-207-5019 to report their NPI information or to obtain more information. NPI and MassHealth Except for the provider types and other entities listed above, you must send your NPI information to MassHealth immediately. Your NPI will replace the MassHealth billing (pay-to) provider number and, if applicable, rendering (servicing) provider number on your claims. To ensure that we receive all of the information we need about your NPI, we have developed NPI spreadsheets—one for professional providers and one for institutional providers. By completing and submitting the applicable spreadsheet to MassHealth, you are providing all of the information we need about your NPI and taxonomy to update our files. The spreadsheets and accompanying instructions are available on the MassHealth Web site at www.mass.gov/masshealth/npi. If you do not have access to the Web, please contact MassHealth Customer Service at 1-800-841-2900 or fax your inquiry to 617-988-8974. Existing MassHealth Attachment A contains charts indicating which provider identifiers should Provider Number be used for certain inpatient MassHealth transactions. Claim Submission Electronic Claims Updates For claims submitted electronically using the 837I (institutional) or 837P (professional) transaction, the provider must enter the applicable NPI and taxonomy numbers. Please refer to the implementation guide for appropriate placement of NPI and taxonomy information for electronic transactions. (continued on next page) Claim Submission MassHealth will issue updated versions of the following electronic Updates transaction companion guides to reflect the changes in billing procedures (cont.) needed to accommodate NPI and taxonomy: * 837I: Health Care Institutional Guide * 837P: Health Care Professional Guide These companion guides are available on the MassHealth Web site. Go to www.mass.gov/masshealth. Click on MassHealth Regulations and Other Publications, then on Provider Library. The Provider Claim Submission Software (PCSS), the free software for submitting MassHealth claims, has been updated to accept NPI and taxonomy. You can download the software upgrades and PCSS user guides from the MassHealth Web site. Paper Claims UB-04 Claim Form. Beginning May 23, 2007, all providers who currently submit paper claims on the UB-92 must submit their paper claims on the UB-04. The UB-04 is a universal claim form that replaces the UB-92 claim form. You can request copies of the UB-04 by contacting your forms vendor. New billing instructions for paper submission of the UB-04 will be posted to the MassHealth Web site shortly. MassHealth is not making changes to the requirements for submitting claims; providers must continue to use the same information to complete the UB-04 fields as they use for completing the corresponding fields on the UB-92. Please refer to your MassHealth billing instructions for applicable codes. In addition, please note the following instructions for fields that are not easily mapped to the new claim form. * Field 7 – Enter the covered days. * Field 37 – Enter the noncovered days, if applicable. * Field 45 – Enter the billing date. * Field 56 – Enter your national provider identifier (NPI). * Field 57A – Enter your other provider number, if necessary. * Field 64A – Enter the transaction control number (TCN) for adjustments or resubmittals. MassHealth Paper Claims. MassHealth has modified its claim forms to include fields for NPI and taxonomy. The new claim forms are available now. The only change to these forms is the addition of the new fields. All other fields remain the same. However, on claim form no. 5, MassHealth also changed field 23A to accommodate the rendering provider’s NPI and taxonomy. (continued on next page) Claim Submission Providers can request supplies of the new paper claim forms by accessing Updates the Order Provider Publications Web page or by calling MassHealth (cont.) Customer Service. Attachment B describes where you will need to enter NPI and taxonomy information on the revised forms. MassHealth will also post to its Web site new claim-form-specific paper billing instructions to reflect changes for NPI and taxonomy. These paper billing instructions for claim form no. 5 will be posted in the Provider Library on or before May 23, 2007. Updated versions for the UB-04 and claim form nos. 4, 7, 9, and 10 will follow. CMS-1500 Claim Form. Effective May 23, 2007, MassHealth will accept the updated version of the CMS-1500 for Medicare Part B crossover claims submitted on paper. Within the coming weeks, MassHealth will update Subchapter 5, Part 8 of all provider manuals to reflect these changes. Payments and Remittance Advices MassHealth will continue to issue payments and 835 transactions to the MassHealth provider number through June 30, 2007. Starting July 1, 2007, MassHealth will issue payments and 835 transactions to the provider’s pay-to NPI if an NPI was submitted. Paper remittance advices will not contain the NPI, but will detail adjudicated claims to the current MassHealth provider number until further notice. Provider Education To explain the impact of NPI and taxonomy on claims submissions, Sessions MassHealth has scheduled provider education sessions in May. The schedule and registration information are posted on the MassHealth Web site. You can access the appropriate page by clicking on Information for MassHealth Providers, then MassHealth Provider Trainings, then Online Training Request, and then Course Registration. Contingency Plan In accordance with the Guidance on Compliance with the HIPAA National Provider Identifier Rule issued by CMS on April 2, 2007, MassHealth has developed an NPI contingency plan. The goal of the MassHealth contingency plan is to work with providers to ensure that all of their NPI data is processed and validated, and that system testing can occur, which should minimize the impact to providers’ business processes. (continued on next page) Contingency Plan The federally mandated deadline to obtain your NPI and share it with all (cont.) partners with whom you conduct business remains May 23, 2007. Providers should not delay the process of obtaining an NPI, sharing an NPI, or making the necessary business-process changes to transmit an NPI on transactions as a result of this contingency plan. On May 23, 2007, MassHealth will be ready to accept NPI-compliant claims, eligibility- verification, and claims-status transactions. If any of the following conditions apply to a MassHealth provider, that provider may use its seven-digit MassHealth provider number on HIPAA standard transactions and paper claims submissions on and after May 23, 2007: * The provider has not received an NPI. * The provider is not ready to submit transactions with NPI. * The provider has not shared the NPI with MassHealth. * The provider has not received confirmation from MassHealth on its NPI submission. If any of these conditions apply, you are required to share your contingency plan with MassHealth. Requests for contingency plans should be sent to npi@mahealth.net. MassHealth will not deny transactions or interrupt payments if a valid MassHealth provider number is submitted instead of an NPI, according to the preceding criteria. The MassHealth deadline for full NPI compliance for all HIPAA standard transactions and paper claims is September 30, 2007. At that time, any electronic or paper claim transactions received without an NPI will be denied. Communications We will keep you informed of the NPI implementation process and any impact it may have on your MassHealth billing procedures through the MassHealth Web site at www.mass.gov/masshealth/npi. We will also partner with provider professional organizations, and will send updates via messages on the cover page of the paper remittance advice, to keep you informed. You can learn more about the NPI requirement from the link under the Electronic Data Interchange (EDI) and HIPAA section, accessible by clicking on MassHealth and HIPAA on mass.gov/masshealth. Questions If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. Business Functions Changing Effective May 23, 2007 Business Function Whom to Call for Questions Provider Instructions Paper or Electronic Claims Submission MassHealth Customer Service 800-841-2900 Providers must begin using their NPI when submitting claims to MassHealth. Provider Claims Submission Software (PCSS) Providers must use their NPI when submitting claims to MassHealth. Calling MassHealth Customer Services Team (CST) Providers may identify themselves to MassHealth Customer Service with either their current MassHealth provider number or their NPI. Business Functions Not Changing on May 23, 2007 Business Function Whom to Call for Questions Provider Instructions Claims Status Inquiry REVS Help Desk 800-462-7738 Continue to use current REVS User ID and password. Eligibility Verification Prior Authorization APAS 866-378-3789 Continue to use current APAS User ID and password. Preadmission Screening MassPRO 781-890-0011 Continue to use current MassHealth provider number. MMQ MassHealth Customer Service 800-841-2900 Continue to use current MassHealth provider number. Primary Care Clinician (PCC) Referrals Primary Care Clinician for the member Continue to use current MassHealth provider number. National Provider Identifier (NPI) and Taxonomy on MassHealth Paper Claim Forms The chart below identifies where to enter your NPI number and taxonomy on the applicable paper claim forms that you submit to MassHealth on or after May 23, 2007. If you enter a billing NPI (and rendering NPI when required) on the paper claim, you do not need to make an entry in the pay-to and servicing MassHealth provider number fields. UB-04 Field # Field Name Description 56 NPI Enter your billing (pay-to) NPI. 57A Other Provider ID Enter your billing (pay-to) MassHealth provider number if you are not listing your NPI. 81A Taxonomy Enter the taxonomy code applicable for the billing (pay-to) NPI. MassHealth Claim Form No. 4 Field # Field Name Description 1A Billing Provider NPI Enter your billing (pay-to) NPI. 1B Billing Provider Taxonomy Enter the taxonomy code applicable for the billing (pay-to) NPI. 2 Pay To Provider No. Enter your pay-to MassHealth provider number if you are not listing your billing provider NPI in field 1A. 4 Servicing Provider’s Name Enter the servicing provider’s name if you are not listing the rendering provider’s NPI in field 11A. 5 Servicing Provider No. Enter the servicing provider’s MassHealth provider number if you are not listing the rendering provider NPI in field 11A. 11A Rendering Provider NPI Enter the rendering (servicing) NPI. 11B Rendering Provider Taxonomy Enter the taxonomy code applicable for the rendering (servicing) NPI. MassHealth Claim Form No. 5 Field # Field Name Description 1A Billing Provider NPI Enter your billing (pay-to) NPI. 1B Billing Provider Taxonomy Enter the taxonomy code applicable for the billing (pay-to) NPI. 23 Rendering Provider NPI Enter the rendering (servicing) NPI. 23A Rendering Provider Taxonomy Enter the taxonomy code applicable for the rendering (servicing) NPI. 30 Servicing Provider No. Enter the servicing provider’s MassHealth provider number if you are not listing the rendering provider NPI in field 23A. 31 Pay To Provider No. Enter your pay-to MassHealth provider number if you are not listing your billing provider NPI in field 1A. MassHealth Claim Form No. 7 Field # Field Name Description 1A Billing Provider NPI Enter your billing (pay-to) NPI. 1B Billing Provider Taxonomy Enter the taxonomy code applicable for the billing (pay-to) NPI. 2 Pay To Provider No. Enter your pay-to MassHealth provider number if you are not listing your billing provider NPI in field 1A. * Note: If you are a nonemergency transportation provider, you do not have to apply for an NPI. Continue to enter your seven-digit MassHealth provider number in Field 2 (Pay To Provider No.). MassHealth Claim Form No. 9 Field # Field Name Description 1A Billing Provider NPI Enter your billing (pay-to) NPI. 1B Billing Provider Taxonomy Enter the taxonomy code applicable for the billing (pay-to) NPI. 1C Rendering Provider NPI Enter the rendering (servicing) NPI. 1D Rendering Provider Taxonomy Enter the taxonomy code applicable for the rendering (servicing) NPI. 2 Pay To Provider No. Enter your pay-to MassHealth provider number if you are not listing your billing provider NPI in field 1A. 5 Servicing Provider’s Name Enter the servicing provider’s name if you are not listing the rendering provider NPI in field 1D. 6 Servicing Provider No. Enter the servicing provider’s MassHealth provider number if you are not listing the rendering provider NPI in field 1D. MassHealth Claim Form No. 10 Field # Field Name Description 1A Billing Provider NPI Enter your billing (pay-to) NPI in this field. 1B Billing Provider Taxonomy Enter the taxonomy code applicable for the billing (pay-to) NPI. 2 Pay To Provider No. Enter your pay-to MassHealth provider number if you are not listing your billing provider NPI in field 1A. * Note: If you are a rest home, you do not have to apply for an NPI. Continue to enter your seven-digit MassHealth provider number in Field 2 (Pay To Provider No.). MassHealth All Provider Bulletin 164 May 2007 Page 5 Attachment A All Provider Bulletin 164 May 2007 Page 1 Attachment B All Provider Bulletin 164 May 2007 Page 1 Attachment B All Provider Bulletin 164 May 2007 Page 2