Do Your Bottom Line a Favor: Meet CMS-1500, NPI Deadlines

Are you ready for April 1? How about May 23? The first date is the deadline to begin using the new CMS-1500 claim form to submit paper claims with public or private payers. By May 23, you must use your 10-digit National Provider Identifier, or NPI, when you file claims electronically. If you don't use the NPI, your claim might be delayed or even rejected.

The NPI was instituted as part of the Health Insurance Portability and Accountability Act of 1996 and is administered by CMS. The identifier never expires or changes. After the switch to the NPI is fully implemented, physicians no longer will need different identifying numbers when filing claims with various health plans -- a welcome step toward administrative simplification.

But getting ready to use the NPI and the revised CMS-1500 claim form, which accommodates the NPI, is not so simple. In addition to applying for and getting an NPI, you must update your computer system to work with the NPI and to print the NPI on the new 1500 claim form. If you use a claims clearinghouse, make sure it's ready to accept your NPI. CMS has estimated that getting ready can take as long as 120 days.

In a letter to HHS last November, the National Committee on Vital and Health Statistics, or NCVHS, which tracks the implementation of the NPI, concluded that significant progress was being made toward compliance. At that time, NCVHS noted, more than 1.4 million NPIs had been issued, which CMS estimated represents about 60 percent of total providers. But NCVHS also noted, "Some key activities may not be completed by the compliance date, which has the potential to disrupt or delay payments to providers."

Will the May 23 deadline for using the NPI be extended? It's anyone's guess. However, if you still don’t have your NPI and haven’t taken steps toward readiness, get started. If the deadline is extended, you'll be ahead of the game. But if the May 23 deadline stands, you'll avoid the possibility of NPI-related claims delays or denials and the resulting impact on your bottom line.