Changes at National Government Services
Rod King, vice president of Provider Outreach and Education, announced integration and standardization changes in leadership at National Government Services (NGS). King continues as vice president at NGS and will be in charge of:
    Customer Care
    Provider outreach
    Enrollment
    Appeals
    Suspension/adjustments

• May 23, 2008, all transactions must include the NPI. If you send Medicare a transaction with a Medicare legacy identifier in any of the provider fields, your claim will be rejected.
  
• Medicare does not require the NPI in item 32a unless the claim is for purchased diagnostic tests. The NPI may be populated in items 17b (referring/ordering provider NPI), 24j (rendering provider NPI) and 33a (billing provider).
  
• A provider who is sole owner of a corporation needs to complete only the CMS 855I. Section 4A was created so a sole owner need not complete the CMS 855B and CMS 855R. However, a sole owner still will be set up as a group because of the corporation listed in section 4A. The physician would obtain an Entity Type 1, Individual. The corporation would obtain an Entity Type 2, Organization. Generally, the corporation’s NPI would represent the billing and pay-to providers (33a) and the physician’s NPI would represent the rendering (24J), referring/ordering (17b).
  
• The NPI will be included in the transaction crossed over to other trading partners.
  
• CMS stopped issuing UPINs in June 2007. The UPIN registry will not be available after May 23, 2008.
  
• For NPI complaints, go here.

Collapsing PTAN
CMS provided instruction on how to collapse Medicare Provider Transaction Access Numbers (PTANs) to insure a one-to-one NPI match. Providers may collapse PTANs assigned to additional locations only if the additional locations are all assigned the same tax identification number (TIN) and are within the same pricing locality.

Complete details may be found on the CMS Web site.

Mission Possible - August 25-28
Mike Davis, manager of Provider Outreach and Education, gave details about the annual NGS convention: Mission Possible. The location is The Convention Center, downtown Indianapolis. The cost is $175 and the event offers 16 continuing education units (CEUs). More details, including hotel information, may be found online.

NGS new Web site demo
The new NGS Web site was launched April 30, 2008. Kelli Templin, E-commerce consultant, provided a demo and overview of the new site.

The Web site contains a tutorial to assist you in locating information. This new NGS Web site is a work in progress. More information will be added and the site will continue to improve.

Issues and Updates
Place of Service
If a physician is interpreting an EKG or doing diagnostic interpretation in his own home and that home is used as an office, the Place of Service (POS) should be 11.

EDS and NPI
Mona Green acknowledged that claims are incorrectly denying for edit 6666, “Anesthesia services not allowed by provider billing for surgery.” These claims are being held and will be adjusted. 
Green reminded attendees that on May 23, 2008, “NPI only” up front edits would be activated. She explained that EDS will attempt to establish a one-to-one match with the NPI and legacy provider identified (LPI) in the following ways:

• The Standard National Provider Identifier (NPI) Crosswalk will use the billing provider office location ZIP code +4 and the billing taxonomy code (if sent).
  
• The Progressive Crosswalk, to be implemented May 23, will use the following data elements in the following sequence:

1. NPI only
   
2. NPI and billing provider taxonomy (if sent)
   
3. NPI and billing provider office location ZIP code+4
   
4. NPI and billing provider office location five-digit ZIP code
   
5. NPI and taxonomy code and billing provider location five-digit ZIP code

• The NPI Default Location, useful for providers with multiple LPIs linked to a single NPI, will give providers the ability to select a “default” billing provider office location that IndianaAIM will use to process claims. 

CareSelect
Marc Baker of MDwise reminded attendees that CareSelect claims are processed by EDS. Therefore, NPI information given by Green and Davidson applies to CareSelect as well. Baker proceeded to discuss the transition of wards and fosters to the CareSelect program. This will begin on July 1, 2008. 

Both Baker and Kelvin Orr of Advantage discussed efforts to encourage providers to enroll in CareSelect programs. Orr indicated that of the 52,725 CareSelect members (as of May 12), approximately 14,000 have not yet been assigned to a primary care physician. Indiana has 13 counties currently underserved by primary care physicians. Orr requested testimonials from physicians satisfied with the CareSelect program. 

Baker discussed CareConnect, the new Web-based care management tool from MDwise. Information on this tool is available on the CareSelect Web site. 

Orr asked that hospice disenrollment forms be faxed to (317) 810-4488 and suggested follow-up with a phone call to ensure the request is being processed. He stated that the information must be received by 4 p.m. to be approved by the next day.

He also reminded attendees that if a patient transitions from one Medicaid program to another, any existing prior authorizations (PAs) will be honored for 30 days. He suggested faxing the approval notice to the new program’s PA area.

Hoosier Healthwise
Anthem’s Jeane Maitland said that, like the Centers for Medicare & Medicaid Services, Anthem would begin utilizing NPI edits on May 23. Dan Westlake advised that MDwise would follow this timeframe as well.

Maitland noted that 8,000 providers have not yet attested their NPIs to the state. This can be done on the Indiana Health Care Program Web site under the NPI Reporting Tool. Maitland also stated that if a provider has an NPI-related claims issue and is unable to obtain resolution via the regular customer service telephone lines, the provider should ask to speak to Minga Williams or Lisa Hutchinson.

Maitland explained that ID numbers for Anthem Hoosier Healthwise members consist of the “YHR” prefix followed by the patient’s RID number. She stated that roster and capitation reports are available on Anthem's web site.  

Maitland acknowledged that newborn claims are denying for “Stay greater than 23 hours, authorization required.” This is an error and these claims are being reviewed.

Michelle Spurlock from Managed Health Services referred attendees to a handout she provided which was a Quick Reference for claim fields affected by the implementation of NPI claims processing. MHS tested NPI only claims on April 15. The high rejection rate caused the date to be delayed to May 20. 

Spurlock announced that on July 1 there will be a change in the process for sterilization consent forms. She also noted that MHS is able to go back only six months to reprint explanation of benefits (EOBs).

Update: Claims Rejected in Error
The electronic data interchange (EDI) National Provider Identifier (NPI) prepass edits requiring that the NPI only be submitted on each claim at every provider level were inadvertently turned on one day early. Because of this, a large percentage of claims were rejected in error.

To correct this, National Government Services (NGS) is taking steps to resubmit the EMC file dated May 22, 2008. You may see duplicate claim notifications and/or rejections. Please disregard any NPI only rejections received between May 23 through May 27, 2008. NGS will have the matter resolved after the May 27 system cycle.