PRACTICE BULLETIN

NPI Updates for Clinical Social Workers

Mirean Coleman, LICSW, CT
Senior Policy Associate

July 2007

Implementation of the National Provider Identifier (NPI) number began on May 23, 2007. Clinical social workers who submit paper or electronic claims are required to obtain the NPI which is a 10 digit numeric number that identifies the provider who provides the service or is submitting a claim for reimbursement. The NPI replaces former individual and group third-party payer provider identification numbers. The NPI assigns each provider one permanent identifier number that is used with all third-party payers.   

The NPI application process is simple, quick, and remains open for clinical social workers who may have missed the May 23rd  deadline or are new independent practitioners starting a private practice. Electronic applications can be made at https://nppes.cms.hhs.gov. Paper applications are available at 1-800-465-3203.

NPI Data Dissemination
The Center for Medicare and Medicaid Services (CMS) recently announced guidelines for public dissemination of NPI data in the Federal Register dated May 30, 2007, notice CMS-6060-N.
Under the Freedom of Information Act (FOIA), CMS has announced that it will not disclose the following NPI information to the public in an effort to prevent or minimize fraud and abuse in the Medicare and health care industry:

1. Provider’s Social Security Number
2. Interval Revenue Service Tax Payer ID number (IRS-ITINS)
3. Date of Birth

The following information may be disclosed:

1. Provider’s Name
2. Business Address
3. Health Care Taxonomy Code
4. Other Provider Identifier and Type Code
5. Provider Enumeration Date
6. Last Update Date
7. NPI Deactivation Revision Code and Date
8. NPI Reactivation Date
9. Provider Gender Code
10. Provider License Number and State Code

CMS has extended the dissemination date of  FOIA disclosable NPI data from July 1, 2007 to August 1, 2007. July 16, 2007 was the deadline by which any updates, changes, and deletions could be made prior to the first initial disclosure date on August 1, 2007.  The Department of Health and Human Services (DHHS) will make the NPI disclosable data available on the Internet at a site to be announced on the CMS NPI Web page http://www.cms.hhs.gov/NationalProvidentStand/ 

Changes
Updates, revisions, or deletions made after July 16, 2007 will be reflected in the next appropriate monthly update file downloadable from the Internet.  Clinical social workers should review the information submitted on their NPI application for accuracy and make revisions or deletions within 30 days of any changes to the National Plan and Provider Enumeration system (NPPES) at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart                     

The fastest and most efficient method to make changes is on the Web site at https://nppes.cms.hhs.gov.  Paper changes may be submitted by contacting the NPPES at 1-800-465-3203 and requesting a copy of the form CMS-1014, which may also be downloaded from the CMS forms page at http://www.cms.hhs.gov/cmsforms/.   Changes may not be made by telephone, fax, or e-mail. 

Forms and Software
The CMS-1500 Form has been revised to accommodate the NPI.  Effective July 2, 2007 providers submitting paper claims must use the CMS-1500 Form, version (08-05), or their claim will be rejected.

Using software that does not accommodate the NPI could contribute to a claim rejection.  Software vendors have made changes to accommodate the NPI. Clinical social workers should make sure their software is the most current version.

Medicare Remit Easy Print (MREP) software has also been revised to accommodate the NPI and is free.  The latest version is available online:  http://www.cms.hhs.gov/AccesstoDataApplication/02_MedicareRemitEasyPrint.asp

UPIN
As a result of the NPI, effective June 29, 2007, CMS will no longer assign Unique Physician Identification Numbers (UPIN) to Medicare providers. The UPIN Registry, however, may be extended to May 23, 2008.
 
Additional Resources
The NPPES Data Dissemination Notice is available online at: http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPPES_FOIA_Data%20Elements_062007.pdf

National Provider Identifier Standard:
http://www.cms.hhs.gov/NationalProvIdentStand/01_overview.asp