npi testing to npi production

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??