April 2007 Client Newsletter

NPI #’s – A CASH FLOW ISSUE IN JUNE ?

Just as we are getting past the cash flow slow-down due to the annual deductibles another looms on May 23rd. As you probably know by now, NPI #’s are required for payment on and after May 23rd.

CPB strongly encourages you to be very frugal with your cash until we see how this conversion progresses thru the end of June.

We have also filed the #s with various insurers as we are aware of their needs. The following insurers have received your NPI #’s:

Aetna
AmeriGroup
AmeriHealth
AtlantiCare
GHI
HealthNet
Health Partners
Horizon Blue Shield
Operating Engineers 835
Unicare
United Healthcare (3/20/07 call received that all clients had been set up).

NJ Medicaid said it is getting them from the electronic files when we send claims - which we suspect other insurers are doing also.

We have not seen a request from any other insurers. If you have requests from others please send them to CPB ASAP so we can handle.

In January CPB began sending NPI #’s for all providers without any problem. In early March CPB began sending NPI #’s for:

1. Referring physicians
2. Office locations
3. Facilities (hospitals, nursing homes, etc.) locations.

So far no problems have been found on these either.

We are still being told that the dissemination notice allowing for public availability of the NPI #’s will be released "soon" by HHS. This is critically important as they will be required on May 23rd for referring physicians (in place of UPINs). Thousands of these need to be loaded into billing systems nationwide so the electronic file is critical. We will do it manually, if necessary, but HHS says they will make this file available “shortly.”

We are hearing that there will be a contingency plan put in place prior to May 23rd. All entities required to use or accept the NPI will continue to be expected to be ready to use the NPI; however, CMS recognizes that the system will not be ready to go by the 23rd. If the contingency plan exists it has not been released yet. Stay tuned.


Billing for Medications

Effective April 1, 2007 we will be required to send the NDC (National Drug Code) 11 digit # to get paid for medications. NJ Medicaid is the only insurer we are aware that wants it now but suspect others will follow. If you receive anything on this from insurers please be sure to forward it to us ASAP. The NDC # is specific to:

o Each medication
o Dosage, and
o Manufacturer / labeler.

Which means we will need that information on each charge slip in order to select the correct NDC #. We do have that chart, of course, and will select with the above information.