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Division of Health Care Financing & Policy (DHCFP)

Division of Health Care Financing & Policy (DHCFP). National Provider Identifier (NPI) Public Workshop. Two phases to implement this process:. Phase I- Overview Present project overview and objectives Gather information from the provider community Phase II-Implementation of Solution

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Division of Health Care Financing & Policy (DHCFP)

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  1. Division of Health Care Financing & Policy(DHCFP) National Provider Identifier (NPI) Public Workshop

  2. Two phases to implement this process: • Phase I- Overview • Present project overview and objectives • Gather information from the provider community • Phase II-Implementation of Solution • Collaborate to determine system/processes to be used • Employ solution

  3. What is the DHCFP trying to do? • Obtain the total number of Medicaid personal caregivers within the state of Nevada and catchment areas • Ensure the number of caregivers meets the needs of the growing Medicaid population • Improve quality of care by ensuring recipients receive the care they need • Assist providers by offering a business system tool • Contain the cost of the program by avoiding inaccurate billing

  4. What is meant by “Registry”? • Employers will provide or make available, the names of their individual caregivers that are used to provide services to Medicaid recipients • A registry IS NOT a public list of all caregivers nor are there plans to release this information publicly • A registry IS NOT a credentialing tool or verification system • Caregivers will need to have a unique personal identification number to track across agencies • One way to obtain a unique personal identification number is to obtain an NPI

  5. What is a NPI? • A NPI is a federally issued, standard, unique identification number for health care providers and health plans. • The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. • There is no cost associated with obtaining a NPI and the estimated time to complete the application is 20 minutes. • Turnaround time for obtaining a number is almost instantaneous.

  6. Why use a NPI? • A NPI uses personal data such as an SSN and date of birth when issuing the number • Less likelihood of misidentifying or duplicating a caregiver • The current Medicaid system, MMIS, does not have capabilities to capture this information • A provider's NPI is permanent and remains with the provider regardless of job or location changes. • It is a national number to assist tracking caregivers across states • Providers would no longer have to keep track of multiple numbers, NPI could be used as employee ID, etc

  7. What InformationisRequired for Individual Providers? • Provider Name • Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN)-if not eligible for SSN • Provider Date of Birth • Country of Birth • State of Birth (if Country of Birth is U.S.) • Provider Gender • Mailing Address • Practice Location Address and Phone Number • Taxonomy (Provider Type) • State License Information • Contact Person Name • Contact Person Phone Number and E-mail

  8. How do I get an NPI? • You can apply on line at https://nppes.cms.hhs.gov,by calling (800) 465-3203, by sending the completed signed application to: • NPI Enumerator • P.O. Box 6059 • Fargo, ND 58108-6059 • More information can be found at: https://nppes.cms.hhs.gov

  9. Anticipated Provider Benefits if a Software Solution is Implemented • Ease of scheduling visits • Reduced administrative time to administer program • Standardization of processes • Reduction of paper-based processes • Reduction in overhead • Real time alerts of scheduling problems (missed visits, late visits, unscheduled visits, etc) • Automated claim generation and submittal • Improved billing accuracy

  10. Cont.. • Increased speed of payment (most claims should be clean and approved on first pass) • Improved cash flow • Schedule only approved units • Improved accountability of service providers • Enhanced information on clients, visits and service providers to help gain efficiency in operations • Access to real-time visit data

  11. Recipient Benefits • Improved service delivery • Adherence to care plan • Improved quality of care • Improved coordination of care/allows for coordination of care across programs

  12. Questions & Comments

  13. Your participation is appreciated

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