|
|
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. HIPAA-covered entities, such as providers completing electronic transactions, health care clearinghouses, and large health plans, must use only the NPI to identify covered health care providers in standard transactions by May 23, 2007.
Important!
CMS has decided to allow covered entities, which includes pharmacies and health plans, up to 12 months, before requiring pharmacy and prescriber NPIs on prescription drug claims and other health care claims, however, health plans may elect to require NPIs sooner. The contingency plan allows for acceptance of legacy identifier numbers such as a pharmacy’s NCPDP number on health care claims, but not beyond May 23, 2008.
- All Pharmacies must obtain a National Provider Identifier (NPI) by the implementation date of May 23, 2007.
- Obtaining a Pharmacy NPI is essential; a Pharmacist NPI is optional unless the Pharmacist is the billing unit.
- Multiple NPIs may be needed for a Pharmacy.
- Register your Pharmacy NPI with NCPDP to avoid potential disruptions in workflow and prescription drug claims payment.
CMS Announces NPI Contingency Plan
CMS has decided to allow covered entities, which includes pharmacies and health plans, up to 12 months, before requiring pharmacy and prescriber NPIs on prescription drug claims and other health care claims. As most health providers know, May 23, 2007, is the deadline for covered entities to comply with HIPAA’s National Provider Identifier (NPI) regulations, however, CMS has announced it will allow contingency plans to be implemented by covered entities that are making good faith efforts to meet the compliance date, but cannot fully comply. The contingency plan allows for acceptance of legacy identifier numbers such as a pharmacy’s NCPDP number on health care claims, but not beyond May 23, 2008. However, health plans may elect to require NPIs sooner.
NCPA is working with State Medicaid programs and health plans to assess the readiness of their provider communities to implement contingency plans to avoid payment disruptions and maintain pharmacy cash flow and patient access to prescription medicines and health care supplies while continuing to work toward compliance. Pharmacies should obtain a NPI and also report their NPI to NCPDP right away if they have not done so already (see instructions below).
NCPDP will maintain the pharmacy’s NPI in a database that matches a pharmacy’s NPI with its former NCPDP number. This information is available to health plans to crosswalk the pharmacy’s NPI with the pharmacy contact information in the health plan database. Without health plan access to this crosswalk there is a significant possibility of claims disruption. There is no cost to obtain a NPI and share it with NCPDP. Further information concerning NPIs is available on the CMS Web site.
|
Provided by the National Community Pharmacists Association (NCPA) and the National Council for Prescription Drug Programs (NCPDP):
» Download the FAQs PDF (150k)
|
