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NPI on the Fly

October 1, 2006
by root
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Horizon Blue Cross Blue Shield of New Jersey found outside help in its quest to manage the NPI conversion process.

Horizon Blue Cross Blue Shield of New Jersey (Newark) recently contracted with Philadelphia-based Portico Systems to help manage its conversion from existing provider identifiers to new NPI (National Provider Identifier) numbers.

BCBS NJ will use Portico's Registrar, Provider, Gateway and Foundation modules, essentially building a "crosswalk" so providers' new NPIs can link up with legacy identifiers still living in the payer's system. Anne Quigg, director of e-business at BCBS NJ, explains that this will mitigate the risk faced by insurers like BCBS NJ until they are ready for a full conversion to the new NPIs.

All healthcare providers are mandated by the 1996 Health Insurance Portability and Accountability Act (HIPAA) to get an NPI, with the goal of simplifying the administration of healthcare claims. The deadline for NPI adoption by health plans such as BCBS NJ is May 23 of next year.

Despite the apparent simplicity of such a conversion, the practice is leaving many with more questions than answers. The main area of confusion, according to Quigg, is in the area of Type II enumerators — those for organizations. That's because provider organizations, she says, often use multiple identifiers with payers so they can differentiate between offices and specialties within the group.

Though the Centers for Medicare and Medicaid Services (CMS) will allow for subpart NPIs — which could match up with the existing sub-organization identifiers — she says, "I think that people are not clear on that, but you will still need that level of detail if you want to maintain relationships that have been previously negotiated with payers."

It is also unclear, Quigg says, whether insurers are supposed to go to all their affiliated providers and collect the new NPIs or whether bodies like the National Plan and Provider Enumeration System (NPPES) — managed by Fox Systems (Scottsdale, Ariz.) under contract to CMS — will manage the distribution of those new numbers.

With all the uncertainty, Quigg says, BCBS NJ decided to leverage an outside vendor — one that had been fully devoted to managing the NPI process — to handle conversion. "So this buy-versus-build question came up, and I think we opted to buy for consistency and standardization. This one was big enough that I don't think you wanted to be out there on your own"

Author Information:

Anthony Guerra