National Provider Identifier (NPI) Configuration
What Is National Provider Identifier?
National Provider Identification (NPI) numbers are unique, 10-digit identification numbers that are used by all health care providers, health plans, and health care clearinghouses effective May 23, 2007.
Currently, health plans assign identification numbers to health care providers. As the result, providers who do business with multiple health plans have multiple identification numbers. The NPI will replace all other provider IDs assigned by various payers.
Due to this regulation, two sections are added to the Claim Alerts report in Reports>Financial: Missing Physician NPI and Missing Provider NPI (For more information, see Claim Alerts Report in the Financial User's Guide).
The first section displays the names of physicians that have NPI numbers. The report identifies the patient and physician combination that does not have an NPI defined. To resolve this, you have to identify whether the physician has an NPI value assigned in Resource>General>Roles. If an NPI value is not defined, obtain the appropriate NPIs from the physician and enter them. The NPI assigned in Individual Physician NPI defaults to the NPI value in Patient>General>Admissions & Status. If a number other than the default must be included in the electronic claim, open the Patient component and select the appropriate NPI in the Admissions & Status window.
The second section identifies whether there are payers that do not have an NPI associated but are configured to report the NPI in the electronic billing file. To resolve missing provider NPI numbers, you have to identify the appropriate NPI for the payer in Insurance Codes – NPI Tab or Insurance Companies – NPI Tab in Administration>Financial.
You can also find the examples of the file formats which can be used for data importing (including staff and physician NPIs) using the Service Import window in Transactions>General.
National Provider Identifier Workflow
Proceed with the following steps to correctly set up NPI data in the application:
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In Administration>Configuration>Business Units, select a Business Unit to define NPI numbers for and click the Provider NPI tab (For more information, see Business Units – Provider NPI Tab in Help). In this window, enter the description of the NPI, the location for which the NPI number applies, and the NPI numbers that your agency received for the selected Business Unit (for example, Home Health). |
If your agency applied for the NPI numbers for each of your Branch locations, those NPI values should be defined here.
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Identify which payers require NPI numbers for electronic billing in Administration>Financial>Insurance Codes. Select the payer for which you want to define NPI rules. On the NPI tab, select the identification numbers that should be included in electronic billing files (For more information, see Insurance Codes – NPI Tab). Options include Legacy IDs (also known as previous provider numbers), National Provider IDs (NPI), and Legacy IDs and National Provider IDs (NPI). |
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If provider numbers vary by branch, select the Branch Level radio button. In the grid, enter the necessary values in the Branch and Provider NPI columns. |
Branches available for selection are defined in Administration>Configuration>Business Units>Branches. The provider NPI numbers available for selection are defined in Administration>Configuration>Business Units>Provider NPI.
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If electronic billing is completed for insurance companies, define the identification numbers that should be submitted in the electronic billing file in Administration>Financial>Insurance Companies>NPI (For more information, see Insurance Companies – NPI Tab). Options available for insurance company electronic billing files include Legacy IDs, NPIs, Both Legacy and NPIs and use the insurance code selection criteria. |
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Print a report with missing NPI numbers for resource. This report can be found in Reports>General>Resources NPI Numbers (For more information, see Resources NPI Numbers in Help). Select the Missing NPI Numbers mode to identify the resources for which you do not have an Individual NPI number associated. |
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Enter the NPI numbers for the resources that do not have an NPI defined. The NPI values are associated with resources in Resource>General>Roles (For more information, see Entering NPI Options for Physician Resource in Help). Enter an individual NPI number in the Individual NPI field and a group NPI number in the Group NPI Table. |
Group NPI numbers available for selection are defined in Administration>General>Group NPI Table.
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Resource's NPI values on the patient level are defined in Patient>General>Admissions & Status (For more information, see NPI Options for Admissions & Status in Help). The default value for NPI is an individual resource NPI number. If a group NPI value must be submitted on the electronic claim, ensure that the Group NPI number is selected within the Admissions & Status window of the appropriate patient. The system does not show a group NPI number by default. It is necessary for your agency to select the appropriate Resource Group NPI. |
NPI values cannot be added while in Field Mode. Field Mode users may choose to use Patient Tasks to assign a task to a Host Mode user that has access to NPI values.
If you currently submit or plan to submit your NPI information in the OASIS submission files, enter your NPI number in the Provider NPI field in the Administration>Configuration>Business Units>Settings>Basic tab. The number entered in this field will only be used for OASIS export files.