What is the National Provider Identifier (NPI)?
The National Provider Identifier (NPI) is a unique, ten-digit numeric identifier assigned to covered health care providers by the National Plan and Provider Enumeration System (NPPES). This identifying number does not carry any information about health care providers, such as the state in which they practice or their provider type or specialization.
The intent of the NPI is to improve the efficiency and effectiveness of electronic transmission by allowing providers and business entities to submit the same identification number(s) to all payers, such as insurance plans, clearinghouses, systems vendors, and billing services.
Individual health care providers are eligible to obtain the Type 1 permanent identifier that will identify the provider for their lifetime. This identifier does not change for this provider regardless of group affiliation, regional location, or licensure changes.
Business entities, which include incorporated individuals, groups, and facilities, are eligible for a Type 2 NPI. With few exceptions identified by CMS, business entities are able to define and obtain one or more NPI to represent their business as they choose.
NPI enumeration is managed by the Center for Medicare & Medicaid Services (CMS) and is part of the overall provisions of the HIPAA Administration Simplification Act.
Why is NPI adoption important?
Blue Shield is accepting and processing electronic transactions using NPI and Tax ID (TIN) only as part of the NPI process. In keeping with the CMS contingency plan, we have extended the period of time before we will reject non-compliant electronic claims. After the May 23, 2007 compliance date, Blue Shield began rejecting incoming 837 transactions that do not contain a valid NPI, when the submitter has identified that they are submitting with an NPI and TIN. Blue Shield will continue to accept submitted electronic transaction without NPI, through the end of 2007. Beginning 1/1/08 Blue Shield will require an NPI to be submitted on electronic transactions. Please see the Blue Shield of California HIPAA Transaction Standard Companion Guide with updated instructions for submitting HIPAA-compliant electronic transactions to Blue Shield of California. For a print version of this guide, please email the eBusiness Data Exchange Help Desk or call (800) 480-1221.
At this time Blue Shield will not require a submitted NPI on paper claims, but will plan to implement this change in the future and strongly encourage adoption of NPI for paper claim submitters. If you are interested in becoming an electronic submitter, this may be the best time to change over to an EDI format. You can get additional information by contacting our eBusiness Data Exchange Help Desk via email or call (800) 480-1221.
Please note that with the adoption of NPI, Blue Shield will be more reliant on matching your submitted demographic information to your provider file. It is critical to keep your provider records up-to-date.
Provider Connection Account Managers can verify the data we have on file for your practice by accessing the Provider Demographic Verification feature. You can review the demographic information we have on file and download a form to update your records. Please ensure you are submitting required fields such as service location, taxonomy codes, billing address, NPI and tax ID number on all applicable submissions.
For more information on how to obtain an NPI, please visit the NPPES website.
How can I test my NPI or TIN with Blue Shield?
Blue Shield wants to ensure that you have a smooth transition when switching over to NPI and Tax ID Number (TIN) only. Please email the eBusiness Data Exchange Help Desk or call (800) 480-1221 if you are interested in submitting a test file. We would be happy to work with you to ensure that our new process is mapping your submitted information correctly. Please remember that a complete claim includes the following data elements to define a billing provider: NPI, TIN, Billing Provider Name, Provider Billing and Service Address, and taxonomy code.
How do I register my NPI with Blue Shield?
We need your help! We need to know your NPI and how it relates to our provider records to ensure a smooth claims transition.
Register your NPI with Blue Shield today. Your NPI can be submitted by fax or U.S. mail. If you are a group or facility with a large roster of providers to register with Blue Shield, please email the eBusiness Data Exchange Help Desk or call (800) 480-1221 for a standard format Excel spreadsheet for submission.
When faxing or mailing your registration to Blue Shield, please include your NPI(s), the Tax ID number and/or PINs related to each NPI, and a contact name and number so we can get in touch with you if we have questions about how you have applied NPI to your practice.
Provider Connection Account Managers have access to our new, online Provider Demographic Verification feature. Account Managers can verify that demographic information is current for each provider record and view how we have linked your NPI(s) to your record(s). An online form is available to update demographic information and that form can also be used to submit your NPI to Blue Shield.
Fax or Mail NPI Notifications and Demographic Verification forms to Blue Shield:
Fax: (916) 350-8860, Attention: NPI Project
Blue Shield of California
Attn: NPI Project
P.O. BOX 629017
El Dorado Hills, CA 95762-9017
How is my NPI different from my Tax Identifier Number (TIN)?
Your NPI is the unique, ten-digit numeric identifier assigned to covered health care providers by the National Plan and Provider Enumeration System (NPPES). Your TIN is the number used to report earnings to the IRS. Both your NPI and TIN are required to submit your claims electronically.
When is Blue Shield going to stop accepting the old professional (HCFA 1500) and facility (UB-92) paper claim forms?
At this time we do not have a firm date. However, we encourage you to begin using the new paper (CMS 1500) and facility (UB-04) forms as soon as possible. We also encourage you to begin using your NPI on the new paper claim forms, though currently this is not a Blue Shield requirement.
To verify Medicare's current requirements, please visit http://www.cms.hhs.gov/NationalProvIdentStand/.
Why are my claims paying differently since I began billing with my NPI?
The NPI program has changed the way we identify providers on claims. We use a cross-reference system that maps your NPI and Tax Identification (TIN) to our provider records. In some cases your NPI relates to multiple Blue Shield provider records. In order to map to the most appropriate record, we are reliant on your demographic information being up-to-date and the submission of a complete claim, including NPI, TIN, Provider Name, Service Address, Billing Address, and Taxonomy Code.
We urge you to have your Account Manager verify your demographics on Provider Connection. If you need to change your information, a demographic verification form can be downloaded and faxed to Blue Shield at (916) 350-8860 to update your record.
Please see the Blue Shield of California HIPAA Transaction Standard Companion Guide with updated instructions for submitting HIPAA-compliant electronic transactions to Blue Shield of California. For a print version of this guide, please email the eBusiness Data Exchange Help Desk or call (800) 480-1221.
When do I start using my NPI?
Your NPI will be required on all electronically submitted transactions by May 23, 2007. Currently, we do not require the NPI on paper claims. However, if you bill through the Blue Card Program (when billing for patients with an out-of-state Blue Plan), an NPI will be required on paper claims.
Why should I bill electronically?
Billing electronically will simplify your data delivery and provide immediate and detailed reporting. This improves your payment cycle times and helps you control your data. In addition, you will enjoy:
- Faster processing time
- No cost for postage
- No cost for claim forms
- Improved security by electronically exchanging data directly with us
- HIPAA compliance
- Greater accuracy
Why are we receiving NPIs on our Electronic Remittance Advice (ERA) prior to May 23, 2007?
Effective April 20th, 2007, BSC began displaying NPI numbers on Provider EOBs and ERAs (835). Providers who have registered their NPI with Blue Shield will have their NPI printed under the Provider Identification Number (PIN) on their EOBs and the NPI will be used as the identifier on ERAs. If the provider has not registered their NPI with Blue Shield, the PIN will appear as it currently does today. If you receive an ERA, but have not registered your NPI, please do so immediately.
If I have more than one NPI registered with Blue Shield, which NPI will be returned on the ERA?
If you have more than one NPI registered with Blue Shield for any provider record, only the primary NPI will be returned on the ERA regardless of the NPI submitted on your claim.
If I send my NPI on my claims before registering it with Blue Shield, will the NPI be returned on my Electronic Remittance Advice (ERA)?
If you submit your claims with an NPI, but have not registered your NPI with Blue Shield, only the PIN will appear on the ERA. Blue Shield will return the NPI we have on file for your provider record - we will not return the NPI submitted on your claim.
How is the NPI returned on my Electronic Remittance Advice (ERA)?
The NPI is returned in the 1000B Loop (Payee Identification) of the ERA.
How does Blue Shield batch the ERAs?
Since we will still process claims using the Blue Shield Provider Identification Number (PIN), the ERAs will be batched based on the Blue Shield PIN used to process the claim(s) as it has been in the past.