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NPI Testing To NPI Production Presented by Gretchen Beicher UW Medical Foundation and Laurie Burckhardt WPS 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 837 P = 266 K clm/mo • FQHC 837 I • Dental 837 D • 835 = 88. 9% of payments posted
o WHAT did we do? o HOW did we do it? o o OPPORTUNITIES we found WHERE WE ARE NOW
CLEAN YOUR OWN HOUSE FIRST o o TEST ENVIRONMENT = PRODUCTION OPPORTUNITIES n Code modifications Legacy Dual Use NPI Only Modified NPI Only for rendering but not referring (Dissemination)
Edit modifications at all provider levels The FAV FIVE 1. 2. 3. 4. 5. FEDERAL TAX ID OR BILLING PROVIDER'S NPI/SSN ARE MISSING RENDERING PROVIDER TAX ID/NPI MISSING OR INVALID SUPERVISING PROVIDER NPI/TAX ID MISSING OR INVALID TAX ID/NPI MISSING OR INVALID REFERRING PROVIDER NPI/TAX ID OR SSN IS MISSING
n n n 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
o Gap Analysis n Top 20 o o o Contracted/Enrollment Biggest Book Document Approach Now we are ready………. maybe? ?
COMMUNICATION With Payors o Who wants and can test? o HOW? o OPPORTUNITIES
o COMMUNICATION Based on multiple factors n n n Gap Analysis Readiness Willingness Relationship Communication Knowledge
o HOW? How and What are we testing? n o o o NPI only or Dual Use or Modified version Produce File? Return Response? Document Outcome Set date(s)
Are we ready? Target Date: May 23, 2007
o o May 18 th – what happened? UWMF contacted by five payors n n n Please test dual Please test NPI only Please send dual without testing Please send NPI only with testing completed
o Opportunities -- Payor 1 – Dual Use Test – Yes n o Payor Provider environment differences Dual Use – 03/14/07 n n n Pre-process reports o MESSAGES, MESSAGES!! Cross walk Ref MDs
o o M 343 rendering provider PIN / NPI combination in loop 2310 B does not exist in Medicare's crosswalk. M 340 - This error indicates that the billing provider PIN (Group Number) / NPI combination in loop 2010 AA does not exist in Medicare's crosswalk M 342 - Referring provider NPI does not exist in Medicare's crosswalk. This edit was turned off shortly after it was turned on. M 329 - The NPI is invalid - based on the Luhn algorithm.
o 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.
o Below are the dates which NPI edits will be turned to delete.
Recommendations for providers: o Begin dual strategy immediately! o Pay close attention to your prepass reports. o 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). o If results are as you expected, increase your volume of NPI only claims.
MLN Matters SE 0725
o Opportunities Payor 1 – NPI Only May 4, 2007 Test file sent n o Results reviewed with payor May 9, 2007 NPI ONLY!!!! n UWMF Timing considerations
Real Opportunity Awaits o o 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 o Cow NPI Summit – June 22, 2007 n What is it? ?
o NPI Controlled Production Testing Portion of Production File o Build Phase 1 n 5 claims/3000 claims Phase 2 n ~790 claims/3000 claims Phase 3 n Full NPI ONLY = August 30, 2007 Consider timing and payment floor for all phases n
NPI Controlled Production Testing o Phase 1 results n n 5 claims/3000 claims sent June 25, 2007 All Claims adjudicated according to standard on July 12, 2007
o NPI Controlled Production Testing Phase 2 n n 500 claims/3000 claims (790+) o August 10, 2007 Three options o Build from scratch o Limit file size and delay other claims o Process when end users on system Timing Medicaid crossover payments were received o September 5, 2007
NPI Only Controlled Production Testing o o o Phase 3 NPI ONLY Target Late August 2007 NPI ONLY August 30, 2007
NPI – ARE YOU USING IT? o YES!!
NPI Testing To NPI Production QUESTIONS? ?