NPI Testing To
NPI Production
Presented by Gretchen Beicher
UW Medical Foundationand
Laurie BurckhardtWPS
September 21, 2007
•University of Wisconsin Medical Foundation•1,000 + Medical School Faculty Physicians •300 Midlevel Providers •51 UW Health clinical practice locations (exclusive of outreach)•837 = 84% majority 837P = 266K clm/mo
•FQHC 837I•Dental 837D
•835 = 88.9% of payments posted
WHAT did we do?
HOW did we do it?
OPPORTUNITIES we found
WHERE WE ARE NOW
CLEAN YOUR OWN HOUSE FIRST
TEST ENVIRONMENT = PRODUCTION OPPORTUNITIES
Code modificationsLegacyDual UseNPI OnlyModified NPI Only for rendering but not referring (Dissemination)
Edit modifications at all provider levels
The FAV FIVE 1. FEDERAL TAX ID OR BILLING PROVIDER'S NPI/SSN ARE
MISSING2. RENDERING PROVIDER TAX ID/NPI MISSING OR
INVALID3. SUPERVISING PROVIDER NPI/TAX ID MISSING OR
INVALID4. TAX ID/NPI MISSING OR INVALID5. REFERRING PROVIDER NPI/TAX ID OR SSN IS MISSING
Sync Enroll DB to PMS MF NPI verifications – Luhn algorithm MF Provider Specialty clean up Taxonomy coordination (Enroll DB v. MF) POS MF clean up
Gap Analysis Top 20
Contracted/Enrollment Biggest Book
Document Approach
Now we are ready……….maybe??
COMMUNICATION With Payors
Who wants and can test?
HOW?
OPPORTUNITIES
COMMUNICATION Based on multiple factors
Gap Analysis Readiness Willingness Relationship Communication Knowledge
HOW? How and What are we testing?
NPI only or Dual Use or Modified version Produce File? Return Response? Document Outcome Set date(s)
Document
Payer or CDF
NPI Disseminated(Enrollment Function)
Test FileSent Date
835 Test Response? Outcome
Dual Use Live Date
File SentDate
835 Test Response? Outcome
UWMF NPI Claims Implementation 2006/2007 NPI Only TestingDual Use Testing
Are we ready?Target Date:May 23, 2007
May 18th – what happened? UWMF contacted by five payors
Please test dual Please test NPI only Please send dual without testing Please send NPI only without testing Please send NPI only with testing
completed
Opportunities -- Payor 1 – Dual Use Test – Yes
Payor Provider environment differences Dual Use – 03/14/07
Pre-process reports MESSAGES, MESSAGES, MESSAGES!!
Cross walk Ref MDs
M343 rendering provider PIN / NPI combination in loop 2310B does not exist in Medicare's crosswalk.
M340 - This error indicates that the billing provider PIN (Group Number) / NPI combination in loop 2010AA does not exist in Medicare's crosswalk
M342 - Referring provider NPI does not exist in Medicare's crosswalk. This edit was turned off shortly after it was turned on.
M329 - The NPI is invalid - based on the Luhn algorithm.
Effective August 27, 2007, for Minnesota and Wisconsin and September 4, 2007, for Illinois and Michigan, WPS Medicare will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to the provider.
Below are the dates which NPI edits will be turned to delete.
Recommendations for providers: Begin dual strategy immediately! Pay close attention to your prepass reports. Send NPI only on a small percentage of
claims (recommended 25 claims). Track claims with NPI throughout the claim process (e.g. compare to your remittance).
If results are as you expected, increase your volume of NPI only claims.
MLN Matters SE0725
OpportunitiesPayor 1 – NPI Only
May 4, 2007 Test file sent Results reviewed with payor
May 9, 2007 NPI ONLY!!!! UWMF Timing considerations
Real Opportunity Awaits
NPI is not only an IT/IS function or number
Payor 1 communication May 11, 2007 What is the difference between EDI
and business reality? Back to Dual Use May 12, 2007
What happened here?
I stole:
“NPI Controlled Production Testing”Credit to Suzanne
Cow NPI Summit – June 22, 2007 What is it??
NPI Controlled Production Testing Portion of Production File
Build
Phase 1 5 claims/3000 claimsPhase 2 ~790 claims/3000 claimsPhase 3 Full NPI ONLY = August 30, 2007Consider timing and payment floor for all phases
NPI Controlled Production Testing
Phase 1 results 5 claims/3000 claims sent June 25, 2007 All Claims adjudicated according to
standard on July 12, 2007
NPI Controlled Production Testing Phase 2
500 claims/3000 claims (790+) August 10, 2007
Three options Build from scratch Limit file size and delay other claims Process when end users on system
Timing Medicaid crossover payments were received
September 5, 2007
NPI Only Controlled Production Testing
Phase 3 NPI ONLY Target Late August 2007 NPI ONLY August 30, 2007
NPI – ARE YOU USING IT? YES!!
NPI Testing To
NPI Production
QUESTIONS??