Provider Specialty Code Table Aug 2006 Update Prepared by the UBO Program Support Team DSN 761-3492 x4072 Eastern Daylight Time Tuesday, 22 Aug 06, 10:00 – 1-866-866-2244, code 7486926# Wednesday , 23 Aug 06, 7:00, 9:00, 14:00 – 1-866-866-2244, code 6087779# Thursday, 24 Aug 06, 0900 - 1-866-866-2244, code 7486926# Friday, 25 Aug 06, 7:00, 10:00 – 1-866-866-2244, code 6087779#
Nomenclature • Provider Specialty Code. These are military unique codes that are used to tell the provider’s specialty. They existed prior to the HIPAA taxonomy. • HIPAA taxonomy. These are relatively new federal codes used to tell a provider’s specialty. There are two different types, individual and agency. This is about individual HIPAA taxonomies. This code says “this provider is a family practice physician.” • National Provider Identifier (NPI). This is a code, rather like a SSAN for a provider. It is a ten digit code that is specific to the individual provider. It says “this provider is Dr. Thomas Alexander White.” There is currently no logic in CHCS that checks the HIPAA taxonomy used when a provider submits for an NPI is the same one used in CHCS. This talk is not about the NPI.
Per my SAIC Contact • For the HIPAA Taxonomy and Provider Specialty update, the SPDS Distribution number is 1146 for the package name CHCS-SS_HPTPS_FY2006_4630-1.0. • HIPAA Provider Taxonomy and Provider Specialty received the final PTTFN and approval to be released for worldwide deployment (18 Aug 06). It is still on schedule for worldwide deployment on 24 August 2006.
Who Might Even Care There Are Changes? • Credentials personnel or whomever enters/updates the provider profile in CHCS • Anyone playing the Military Health System (MHS) Prospective Payment System (PPS) Relative Value Unit (RVU) game • Data analysts who pull data • Anyone who spends money collected through the Third Party Collection program
Objectives • After this brief, as of 24 August 2006 or whenever the update is loaded at your MTF, • properly assign provider specialty code (PSC) for residents, pharmacists, dieticians and independent duty corpsmen and all the other new PSCs 90% of the time • Have a list of provider specialty codes that you commonly use/have at your MTF that will need to be updated when the change occurs
Overview • Why it is important to your MTF to have these correct • Codes inactivated • Codes added • Nomenclatures changed
Important, but not life threatening • I’ve been told that when the codes are inactivated, they will still report up, but just not link for billing and Prospective Payment System • Start changes now, but probably not going to absolutely need them until 1 Oct 2008 (just not enough time to realistically get done by 1 Oct 2007) • Look them over so you can get your residents in correctly, these would be your first priority
How To Identify Providers Needing to be Updated • There is a possibility of a central pull posted out on the SAIC maintenance website of active providers with coded encounters within the past year with provider specialty codes needing updating. • Otherwise, as a backup, start lining up someone at your MTF who can do an ad hoc of active providers with their provider specialty codes who have submitted SADRs in the past year.
Menu Path --------- Systems Manager Menu (EVE) Core Application Drivers Menu (XUCORE) Data Administration Menu (DOD DA ADMIN) Common Files and Tables Management Menu (DOD F-T BUILD MAIN MENU) Common Files and Tables Maintenance Menu (DOD MAINTAIN F-T) How Did I Get Here (XUSTACK) CFS Common Files Supplementary Menu DEP Department and Service File Enter/Edit HOS Hospital Location File Enter/Edit HPN Host Platform Name Enter/Edit MCD Medical Center Division File Enter/Edit MTF Medical Treatment Facility File Enter/Edit PRO Provider File Enter/Edit STM Standard Insurance Company Table Menu UIC UIC Management Menu ZIP Zip Code File Enter/Edit ACT Inactivate/Reactivate File Entries SIG SIG Select Common Files and Tables Maintenance Menu Option: CHCS Provider Profile
For Those Doing the Provider Specialty Code Updates • Residents without licenses – they need supervision • Residents with licenses – they don’t need supervision (well, not in the CHCS sense of “supervision”)
General Layout • 000-099 Medicine Physicians • 100-199 Surgeons • 200-299 Pathology/Laboratory • 300-399 Aerospace/Occupational/ Preventive/Hyperbaric/Hypobaric Medicine • 400-499 Radiology/Diagnostic Imaging • 500-599 Was consultants, now technicians • 600-699 Nurses • 700-799 Extenders (except PAs at 901) • 800-899 Dentists • 900-909 Technicians (except for PAs who started as enlisted but are now officers) • 910-999 Clinics (not included in the MHS PPS RVU game)
General Rules • You need to ensure you have the correct codes for ALL your Residents – it impacts billing right NOW • Navy requested a number of new, more detailed codes, so I suspect they want them used • Use the code that matches the privileges awarded. For instance, if the provider is an ENT doing ENT, 130. If the provider is a Pediatric ENT doing Pediatric ENT, 135. But, if the provider is a Pediatric ENT at a tiny clinic and was awarded privileges, code it as 130.
Quiz (to see if you were listening) What is new about assigning residents? What is the new code for pharmacists? Why do you need to update dieticians? What is the new IDC code (only for Navy personnel)?
What you really need to remember from this • Contact your System Administrator and ask for the updated HIPAA taxonomy table and the updated Provider Specialty Code table and find out when it will run at your MTF • Fix your residents, pharmacists, dieticians, aerospace physiologists (and all the inactivated codes if you want credit for your work) • For Navy, split out the updated specialties • Now you have a specific place for medical students and pastoral counselors