npi

Instructions Regarding

the Use of the new HCFA 1500 Form

and your NPI Numbers

September 1, 2007

Final deadline for CMS 1500 form

With NPI numbers

Effective September 1, 2007, CNC will only be able to process paper claims that are submitted on the new CMS 1500, with the required NPI numbers in the appropriate boxes.

As you know, June 1 was the effective date for submitting all paper claims to CNC using the new CMS 1500 form, including the required NPI number(s) in the appropriate boxes.   But after learning that a few offices were still waiting for updates from their practice management software companies, the deadline was extended to September 1, 2007.

To date, the vast majority of our providers are now correctly submitting claims on the new form with the appropriate NPI numbers.  However, there are still many practices that are submitting the old HCFA 1500 form OR that are submitting the new form but without the appropriate NPI number(s) in the appropriate boxes.  While we can continue to process these claims submitted without the NPI numbers until September 1, please be aware that the processing time for these claims is significantly longer than normal.

If you are not already submitting your claims correctly to CNC, please make sure that your software is capable of generating these new claims with the NPI numbers in the correct locations and please make sure that your Billing Manager is aware of this important September 1, 2007 deadline.  We understand that it is very frustrating to receive a large packet of claims back from CNC and we do not want to have to return any claims to any provider!  So please make sure you are ready for this deadline!

Additionally, please allow us to assist you with this important change. BEFORE submitting a large batch of claims using the new form with the required NPI numbers, please fax 1 or 2 completed claims to your CNC Provider Representative first!   We will review the claim and:

Confirm that the NPI number(s) on the claim matches the NPI number(s) in our system, (which is necessary for the proper processing of the claim).

Check the claim to make sure the appropriate NPI number(s) are in the correct boxes on the CMS 1500 (Type 1 vs. Type 2, etc.)

Contact you to let you know that your claims are correct and ready to submit

OR let you know if anything needs to be changed BEFORE you submit a large

batch of claims, which would then have to be returned to you!

To start using the new NPI numbers, you must first begin using the new CMS-1500 form – Version 08/05.   The new claim form was specifically designed to allow all insurance companies to accept the NPI numbers. The NPI numbers will replace other provider identifiers previously used by health care providers that were assigned by payers. (Examples of Provider identifiers are your BCBS ID #, UPIN number, Medicare number, etc).

CHANGES TO THE CMS HCFA 1500 FORM

Please note the following changes to the New CMS-1500 form Version 08/05.

Please follow these instructions carefully regarding the proper completion of the new HCFA 1500 form and the use of your NPI number(s).

1. Box 17 (Referring physician).

For claims sent to CNC, Box 17(referring provider) should only be completed if you are billing an E/M consultation code.  The use of these consultation codes are limited to those services performed when another provider referred the patient to you for evaluation and/or management of a specific problem and specifically requested the consultation.

Notice that Box 17a is now split into two sections: 17a & 17b. If you are completing box 17, then box 17b should be completed with the referring provider’s NPI number.  Box 17a is only required if the NPI number is not reported in box 17b. In such a case, then box 17b must contain the referring provider’s provider identifier, such as his/her BCBS ID #.

BCBSNC requires the use of their BCBS ID Qualifier (1B) in the shaded area and to the immediate right of 17a. Enter the BCBSNC ID number of the referring provider in the shaded box to the right of the ID Qualifier.”

2. Box 24 (Service lines)

Box 24 (continued)

Please note that box 24 has a few changes. One is the elimination of the current box 24c “Type of Service” and box 24J “COB” These boxes have been eliminated and are no longer reported on the new CMS forms.

Your Type 1 NPI number must be entered in box 24J in the non-shaded area. During the transitional period, IF APPLICABLE, you must  also enter your proprietary identifier in the shaded area as well as your Type 1 NPI number in the non-shaded area. For example, enter the assigned BCBSNC ID number for the performing Provider in the shaded area and enter the Type 1 NPI number of the performing provider below the dotted line.

3. Boxes 32 and 33 (Service Facility & Billing Provider Information)

Please note that both Box 32a and 33a indicate where you must place your NPI number and are appropriately labeled “NPI” on the form.  Your Type 2 NPI number must be entered in BOTH of these boxes. If you do not have a Type 2 NPI number, you MUST enter your Type 1 NPI number in both of these boxes. During the transitional phase, your provider identifiers (such as your BCBS ID #) must also be placed in boxes 32b & 33b.

The insurance companies and CNC will accept the new CMS-1500 forms as well as the old HCFA 1500 forms until April 2, 2007.  After that date, only the new CMS form will be accepted.    Please check with your Practice Management software companies to assure that they are ready for these important changes regarding the new HCFA 1500 form and the use of your NPI number(s).

Please contact your CNC Provider Representative if you have additional questions about these changes.  We are happy to help!

HAVE YOU OBTAINED BOTH YOUR

TYPE 1 NPI AND YOUR

 TYPE 2 NPI NUMBER?

To obtain your NPI numbers described below, please go to the NPPES website below to fill out your NPI application(s)

https://nppes.cms.hhs.gov/NPPES/Welcome.do

Many of you have already obtained your National Provider Identifier (NPI) numbers and submitted these numbers to CNC.. However, it appears that some providers have only received their Type 1 NPI number, but have not obtained their Type 2 NPI number. A Type 1 NPI number is for the “human” provider whereas the Type 2 NPI number is for the organization, group, or business of the provider.     To clarify:

                                           If your practice is incorporated

                                                                     OR

If you are a member of a group practice (with more than one provider)

You must obtain 2 NPI numbers – both a TYPE 1 NPI as well as a TYPE 2 NPI.

If you are a sole proprietor, you are only required to obtain a TYPE 1 NPI number.