July 2007 Client Newsletter

NPI #’s

The data dissemination notice (for NPI #’s) was put on display on May 23rd at 4:00 for CMS officials to review. CMS is supposed to make it available for download as a file in 30 days with NPIs office addresses, practitioner name, and license number (no SSN).

Approximately 98% of the estimated 2.3 million covered health care providers now have NPIs.
The NPPES Data Dissemination Notice (CMS-6060-N) was published on May 30, 2007. NPPES health care provider data that are required to be disclosed under the Freedom of Information Act (FOIA) will be made publicly available.

CMS believes that health care providers need additional time, beyond what was afforded in the Data Dissemination Notice, in which to view their FOIA-disclosable NPPES data and make any updates or deletions (where permitted) that they feel are necessary. Therefore, CMS has decided to delay the dissemination of FOIA-disclosable NPPES health care provider data until August 1, 2007, 60 days after the publication date of the Notice.

CMS will provide additional information in the near future with respect to the date by which changes would have to be submitted in order to be reflected in the initial downloadable file. CMS understands that the health care industry is in urgent need of the FOIA-disclosable NPPES health care provider data; however, CMS believes it is in the best interests of the industry, and the health care providers in particular, that the NPPES data we will be disclosing be as accurate as possible.

Paper Attachments for Medicare Claims.

Effective July 1, 2007 Empire Medicare (NGS) Part B has indicated it will no longer accept paper attachments for electronic claims prior to submission of the claims. Claims that require supporting documentation should be submitted electronically. When the claim is received for processing, if documentation is required for adjudication of that claim, Medicare will send an automatic request to the provider of service requesting additional documentation. The provider has 45 days to submit the information to Medicare. We expect that these letters will come direct to each client which you will then need to forward to CPB as soon as possible so that we do not miss the 45 day deadline.

In the past, Medicare allows us to fax documentation to them seven days in advance which they would then match to the electronic claim.