|IS YOUR MEDICAL SOFTWARE ANSI 5010 COMPLIANT?
|NPI and HIPAA Compliance for Medisoft and Lytec
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique
health identifier for health care providers. On January 23, 2004, the Secretary published a Final Rule adopting the National Provider Identifier (NPI) for this
requirement. All HIPAA covered healthcare providers, whether they are individuals or organizations, must obtain an NPI to identify themselves in HIPAA standard
transactions. Once established, a provider's NPI will not change. The NPI remains with the provider regardless of job or location changes.
Effective May 23, 2007, the Centers for Medicare & Medicaid Services (CMS) claims processing systems will only accept claims that include NPI numbers. At
the same time, all providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use the NPI to identify covered
healthcare providers in standard transactions.
Now is the time to prepare and to ensure that providers using Medisoft can continue to send electronic claims after the May 2007 deadline!
The link to apply for an NPI number https://nppes.cms.hhs.gov/NPPES/Welcome.do
NPI Timeline Schedule
Medicare's implementation involving acceptance and processing of transactions with the NPI will occur in separate stages, as shown in the table below:
May 23, 2005 - Jan 2, 2006: Providers should submit Medicare claims using only their existing Medicare numbers. They should not use their NPI numbers
during this time period. CMS claims processing systems will reject and not process any claim that includes an NPI during this phase.
Jan 3, 2006 - Oct 1, 2006: Medicare systems will accept claims with an NPI, but an existing legacy Medicare number must also be on the claim. Note that
CMS claims processing systems will reject and not process any claim that includes an NPI only.
Medicare will be capable of sending the NPI as primary provider identifier and legacy identifier as a secondary identifier in outbound claims, claim status
response, and eligibility benefit response electronic transactions.
Oct 2, 2006 - May 22, 2007: CMS systems will accept an existing legacy Medicare billing number and/or an NPI on claims. If there is any issue with the
provider's NPI and no Medicare legacy identifier is submitted, the provider may not be paid for the claim.
Therefore, Medicare strongly recommends that providers, clearinghouses, and billing services continue to submit the Medicare legacy identifier as a secondary
Medicare will be capable of sending the NPI as primary provider identifier and legacy identifier as a secondary identifier in outbound claim, claim status response,
remittance advice (electronic but not paper), and eligibility response electronic transactions.
May 23, 2007 - Forward: CMS systems will only accept NPI numbers from all providers completing electronic transactions, healthcare clearinghouses, and
large health plans. Small health plans have an additional year to be NPI compliant.
IS YOUR MEDICAL SOFTWARE/SYSTEM ANSI 5010 COMPLIANT?
CALL US TODAY TO FIND OUT HOW TO COMPLY WITH AND GET THE RIGHT VERSION OF LYTEC AND MEDISOFT TO FULFILL ANSI 5010
REQUIREMENT! THIS IS A TEST
NPI REQUIREMENT DEADLINE IS HERE! All versions prior to Medisoft version 11 and Lytec 2006 are incapable of storing the NPI on the
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