Npi testing to npi production
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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


Npi testing to npi production

  • 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


Npi testing to npi production

  • WHAT did we do?

  • HOW did we do it?

  • OPPORTUNITIES we found

  • WHERE WE ARE NOW


Npi testing to npi production

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)


Npi testing to npi production

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


Npi testing to npi production

  • 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


Npi testing to npi production

  • Gap Analysis

    • Top 20

      • Contracted/Enrollment

      • Biggest Book

  • Document Approach

    Now we are ready……….maybe??


Npi testing to npi production

COMMUNICATION With Payors

  • Who wants and can test?

  • HOW?

  • OPPORTUNITIES


Npi testing to npi production

COMMUNICATION

  • Based on multiple factors

    • Gap Analysis

    • Readiness

    • Willingness

    • Relationship

    • Communication

    • Knowledge


Npi testing to npi production

HOW?

  • How and What are we testing?

    • NPI only or Dual Use or Modified version

  • Produce File? Return Response?

  • Document Outcome

  • Set date(s)


Npi testing to npi production

  • Document


Npi testing to npi production

Are we ready?

Target Date:

May 23, 2007


Npi testing to npi production

  • 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


Npi testing to npi production

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


Npi testing to npi production

  • 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.


Npi testing to npi production

  • 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.


Npi testing to npi production

  • Below are the dates which NPI edits will be turned to delete.


Npi testing to npi production

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.


Npi testing to npi production

MLN Matters SE0725


Npi testing to npi production

Opportunities

Payor 1 – NPI Only

  • May 4, 2007 Test file sent

    • Results reviewed with payor

  • May 9, 2007 NPI ONLY!!!!

    • UWMF Timing considerations


Npi testing to npi production

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?


Npi testing to npi production

I stole:

“NPI Controlled Production Testing”

Credit to Suzanne

  • Cow NPI Summit – June 22, 2007

    • What is it??


Npi testing to npi production

  • 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


Npi testing to npi production

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


Npi testing to npi production

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


Npi testing to npi production

NPI Only

Controlled Production Testing

  • Phase 3 NPI ONLY

  • Target Late August 2007

  • NPI ONLY August 30, 2007


Npi testing to npi production

NPI – ARE YOU USING IT?

  • YES!!


Npi testing to npi production1

NPI TestingToNPI Production

QUESTIONS??


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