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Division of Health Care Financing & Policy
(DHCFP)
National Provider Identifier (NPI)
Public Workshop
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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
Two phases to implement this process:
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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
What is the DHCFP trying to do?
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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
What is meant by “Registry”?
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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.
What is a NPI?
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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
Why use a NPI?
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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
What Information is Required for Individual Providers?
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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
How do I get an NPI?
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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
Anticipated Provider Benefits if a Software Solution is Implemented
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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
Cont..
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Improved service delivery
Adherence to care plan
Improved quality of care
Improved coordination of care/allows for coordination of care across programs
Recipient Benefits
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Questions &
Comments
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Your participation is appreciated
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