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 NPI
Application Deadline Reminder:
Compliance Date Rapidly
Approaching
All pharmacies must have an NPI
by May 23, 2007.
HIPAA covered entities,
including all pharmacies, are required to
begin using the National Provider Identifier (NPI) by
May 23, 2007. Apply for the NPI now in order to
meet the fast approaching deadline - it can take up to four
months to process an NPI application. Pharmacists may apply
for an NPI online or print a paper application from
https://nppes.cms.hhs.gov.
Or you may call for more information 1-800-465-3203 (NPI
Toll-Free)
NPI
and Medicaid
If your pharmacy participates in the medical
assistance programs, you must also submit your pharmacy NPI,
once you obtain it to the Office of Medical Assistance
Programs. Medicaid billing will start requiring NPI
numbers. You may do this online or by paper. Details on
how this is done can be found at
http://www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinId=1536
Providers must have their NPI submitted to Medicaid by April
16.
Note: Pharmacists may
apply for individual NPIs if so desired for potential future
use – but these are not to be reported to Pennsylvania
Medicaid.
The following information
appeared in the November/December edition of the
Pennsylvania Pharmacist and is being reprinted below –
just in case you missed it.
National
Provider Identifier (NPI)
NPI History
Per HIPAA regulations, any
pharmacy which transmits electronic claims must obtain a
national provider identifier, or NPI, by May 23, 2007.
After this date, the NPI will be the only identifier used to
transmit electronic claims to sources such as Medicaid,
Medicare, and third-party payers. All pharmacies must
obtain an NPI and while it is not necessary for
individual pharmacists to register for an NPI, PPA highly
recommends it. Pharmacists applying for an individual NPI
will benefit in the long-run, because it may serve as an aid
in future billings as Medication Therapy Management
continues to evolve.
What
is the NPI?
For pharmacies which currently
use an identifier number provided by the National Council
for Prescription Drug Programs (NCPDP), the NPI will be
replacing the NABP number, and be the sole identifier for
submitting electronic claims. The NCPDP will be known as
the “enumerator,” and will assign all NPI numbers to
pharmacies. The NPI is a unique 10 digit identification
number, and once a provider obtains an NPI, it does not
change. It is issued for life. The NPI is considered
“intelligence free,” and this means that it can not be
linked to a specific provider. It is important to note,
however, that the previous issued NCPDP numbers will not be
completely obsolete. The NCPDP will continue to keep
pharmacies’ NCPDP numbers, and they may be used for internal
reasons (such as updating databases). However, it is not an
option to obtain an NPI, because to submit any HIPAA related
transactions, an NPI must be used.
Significance
of NPI
By all pharmacies obtaining an
NPI, this allows for all health care providers to have a
standard number and this will help with the simplicity of
submitting electronic transactions.
What
is an EFIO?
An EFIO is a term that you may
hear about often and it stands for Electronic File
Interchange Organization. An EFIO is certified by the
Center for Medicaid and Medicare Services (CMS ) to serve as
an “agent” to electronically file an application for an NPI,
and then distribute the NPI to an authorized provider. The
EFIO may also submit changes to provider information such as
address, telephone number, etc. EFIO’s must receive
authorization through their enumerator before they are able
to perform any of the above functions. NCPDP is a certified
EFIO, and this is why pharmacies may apply through them, and
can also receive their NPI from them.
How
Do I Apply for an NPI?
The National Provider and Plan
Enumeration System (NPPES) is the system that will be used
to gather information about a provider in order to issue
them an NPI. The easiest way to apply for an NPI for both
your pharmacy and yourself as a pharmacist is to visit the
National Plan and Provider Enumeration System website at
https://nppes.cms.hhs.gov.
Once you get to the website, you can follow the instructions
to easily obtain your NPI.
Another way to apply for your
NPI is to fill out a paper application and mail it to the
enumerator. Pharmacies can access NCPDP applications by
visiting the following CMS website:
http://www.cms.hhs.gov/NationalProvIdentStand/03_apply.asp#TopOfPage.
A copy of the application is
also being attached with this memo, to allow you to print
out the application and mail it to the enumerator. Once
your application has been received, the NCPDP will notify
you with your NPI via email. There is a 6 day turnaround
time for the NCPDP to process your application, notify you
of any problems, and distribute your NPI. It is important
to provide NCPDP with the correct information, because NCPDP
may need to contact your pharmacy with any questions about
the application.
Where Can I Get More
Information?
For more information regarding
NPI’s, please visit
www.ncpdp.org or
visit
http://www.ncpdp.org/frame_news_npi-info.htm.
You can also contact the NPI Enumerator system by calling
1-800-465-3203 (NPI Toll-Free) with
any questions you may have.
Research completed and
article prepared by Holly L. Hicks, 2007 PharmD Candidate at
Wilkes University Nesbitt School of Pharmacy and Nursing.
Sources:
-
NCPDP.org [homepage on
the Internet]. Arizona: National Council for
Prescription Drugs Program [accessed 2006 Aug 7].
Available from:
http://www.ncpdp.org/frame_news_npi-info.htm
-
VTmedicaid.com [homepage
on the Internet]. {accessed 2006 Aug 7]. Available
from:
http://vtmedicaid.com/Information/NPIFAQ.pdf
-
cms.hhs.gov [homepage on
the Internet]. Centers for Medicare and Medicaid
Services [accessed 2006 Aug 7]. Available from:
http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPIFactSheet_010906.pdf
-
MGMA.com
[homepage on the Internet]. Medical Group Management
Association; c2003-06 [accessed 2006 Aug 7]. Available
from:
http://www.mgma.com/press/NPIenumeration.cfm
Your Feedback needed!
Tell us what else you need to know about Medicare.
Send your questions to
ppa@papharmacists.com
and mark Medicare ? in the subject line.
We will work on establishing a Frequently Asked Questions
(FAQ) section next.
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