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NPI Testing To NPI Production. Presented by Gretchen Beicher UW Medical Foundation and Laurie Burckhardt WPS September 21, 2007. University of Wisconsin Medical Foundation 1,000 + Medical School Faculty Physicians 300 Midlevel Providers

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npi testing to npi production

NPI TestingToNPI Production

Presented by

Gretchen BeicherUW Medical Foundationand Laurie BurckhardtWPS

September 21, 2007

slide2

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
slide3
WHAT did we do?
  • HOW did we do it?
  • OPPORTUNITIES we found
  • WHERE WE ARE NOW
slide4
CLEAN YOUR OWN HOUSE FIRST
  • TEST ENVIRONMENT = PRODUCTION
  • OPPORTUNITIES
    • Code modifications

Legacy

Dual Use

NPI Only

Modified NPI Only for rendering but not referring

(Dissemination)

slide5
Edit modifications at all provider levels

The FAV FIVE

  • FEDERAL TAX ID OR BILLING PROVIDER\'S NPI/SSN ARE MISSING
  • RENDERING PROVIDER TAX ID/NPI MISSING OR INVALID
  • SUPERVISING PROVIDER NPI/TAX ID MISSING OR INVALID
  • TAX ID/NPI MISSING OR INVALID
  • REFERRING PROVIDER NPI/TAX ID OR SSN IS MISSING
slide6
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
slide7
Gap Analysis
    • Top 20
      • Contracted/Enrollment
      • Biggest Book
  • Document Approach

Now we are ready……….maybe??

slide8
COMMUNICATION With Payors
  • Who wants and can test?
  • HOW?
  • OPPORTUNITIES
slide9
COMMUNICATION
  • Based on multiple factors
    • Gap Analysis
    • Readiness
    • Willingness
    • Relationship
    • Communication
    • Knowledge
slide10
HOW?
  • How and What are we testing?
    • NPI only or Dual Use or Modified version
  • Produce File? Return Response?
  • Document Outcome
  • Set date(s)
slide12
Are we ready?

Target Date:

May 23, 2007

slide13
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
slide14
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

M329

M340

M342

slide15

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.
slide16
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.
slide18
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.
slide20
Opportunities

Payor 1 – NPI Only

  • May 4, 2007 Test file sent
    • Results reviewed with payor
  • May 9, 2007 NPI ONLY!!!!
    • UWMF Timing considerations
slide21
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?

slide22
I stole:

“NPI Controlled Production Testing”

Credit to Suzanne

  • Cow NPI Summit – June 22, 2007
    • What is it??
slide23
NPI Controlled Production Testing
    • Portion of Production File
      • Build

Phase 1

    • 5 claims/3000 claims

Phase 2

    • ~790 claims/3000 claims

Phase 3

    • Full NPI ONLY = August 30, 2007

Consider timing and payment floor for all phases

slide24
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
slide25
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
slide26
NPI Only

Controlled Production Testing

  • Phase 3 NPI ONLY
  • Target Late August 2007
  • NPI ONLY August 30, 2007
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