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The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) mandate that all health care providers conducting standard electronic transactions apply for and use a unique standard identifier called the National Provider Identifier (NPI) effective May 23, 2007.  The NPI is also being adopted for use on the revised 1500, UB-04, and American Dental Association (ADA) billing forms.

In early 2005 the Centers for Medicare and Medicaid Services (CMS) awarded the NPI Enumerator contract to FOX Systems, Inc. In this role, FOX processes provider NPI applications, issues new NPI’s and operates the call center. FOX’s reputation as a national leader in HIPAA IT consulting and solutions, and ability to integrate detailed knowledge of NPI regulations, healthcare systems and business processes, and Enumerator operations is now available to your organization to assist in NPI compliance efforts.

The NPI Challenge to Healthcare Organizations – Compliance with NPI requirements will greatly challenge all healthcare organizations – health plans, providers and clearinghouses – and their HIPAA business associates and trading partners who must also coordinate compliance with all HIPAA requirements.  In the initial industry analyses the impact was thought to be limited and efforts focused on the mechanical aspects of capturing and using a new provider identifier within legacy business processes and systems.  Organizations concentrated on the need to develop clean “many to one” mappings between new provider NPI’s and legacy provider IDs.

More thoughtful discussions concerning impact have now concluded that NPI may affect healthcare organizations as much as the original wave of HIPAA EDI transaction and code set implementations or Y2K. As noted in FOX’s NPI Whitepaper available under “NPI Resources”, there are severe consequences to not being able to meet the NPI compliance deadline as well as risk considerations related to compliance activities. Delayed compliance or non-compliance may result in payment disruptions for providers.  Non-compliance may also create problems in many different business areas including budgeting, forecasting, reporting, claims processing, status, and remittance reporting, eligibility, provider enrollment and credentialing, contracting, authorizations and referrals.  NPI will impact many systems, business processes, and policies and procedures and may disrupt mission-critical functions unless addressed in a timely and comprehensive manner.

By now, organizations should be well on the path to NPI compliance and should have started the process of assessing the impact of NPI on their operations and systems. In fact, it has been recommended that testing must begin February 2006 in order to have sufficient time for implementation.

FOX Approach – We have developed robust methodologies and tools to assess NPI impact on systems and business processes, plan for NPI remediation, and provide remediation services. These have been tailored to the specific needs of health plans and providers and are scalable solutions for organizations of all sizes. Our expert consultants are equipped with detailed and comprehensive Practice Guides which lay out the approach, tasks and methods for NPI compliance. Coupled with our strong internal practices linked to our ISO 9000, staff PMP and other certifications, FOX and our staff can ensure that your NPI compliance project will be successful.

For Additional NPI Resources Click here

FOX Systems, Inc.

Quality  *  Experience  *  Knowledge  *  Automated Tools

6263 North Scottsdale Rd., Suite 200 ● Scottsdale, AZ 85250

Phone (480) 423-8184 ● Fax (480) 423-8108

www.foxsys.com ● www.npicompliance.com