Under the latest HIPAA mandate, all medical providers conducting their business electronically have to apply for a National Provider Identifier (NPI) through the Centers of Medicare and Medicaid Services (CMS). Providers must use the allotted number on all HIPAA mandated transactions from May 23, 2007. This number will replace all their other numbers, including the Medicare number.
Solution
There is no easy answer to implementing NPI - either
on the payer side or on the provider side. At this point, we know that
all legacy numbers cannot be eliminated. For the provider, there may be
instances when payers require the legacy number for an old, non-HIPAA
transaction. As for payers, not every provider is mandated to apply for
a new identifier. Therefore, the only logical solution is to create a
cross-walk.
In a cross-walk solution, payers will need to ensure
the accuracy of provider data utilized by the cross-walk and the NPI data
source (NPPES). They should have the ability to handle a multi-dimensional
cross-walk of:
 |
One NPI to many legacy IDs | |
|
Many NPIs to one legacy ID | |
|
Many NPIs to many legacy IDs |
If implemented incorrectly, payers will require additional handling leading to increased costs in:
|
Unresolved mapping | |
|
Erroneous mapping | |
|
Auditing required | |
|
Manual Intervention |