Important news

Using your NPI – Contingency Plan

On Monday, April 2, 2007, the Centers for Medicare and Medicaid Services (CMS) announced that it was implementing a contingency plan for covered entities who will not meet the May 23, 2007, deadline for compliance with the National Provider Identifier (NPI) regulations under HIPAA. This announcement indicates that covered entities will be protected from enforcement actions if they continue to act in good faith to come into compliance, and if they develop and implement contingency plans to enable them and their trading partners to continue to move toward NPI compliance.

Blue Cross and Blue Shield of North Carolina (BCBSNC) is evaluating CMS's NPI Enforcement Guideline, and will be finalizing a contingency plan. We have already made some specific decisions about what will be included in the contingency plan:

BCBSNC will continue to collect NPIs from providers.
BCBSNC will continue to accept HIPAA-defined transactions submitted with Blue Cross or Blue Shield five-character proprietary provider numbers only (without NPI) after May 23, 2007, but not for the entire duration of the contingency period. The contingency period is intended to allow testing of crosswalks, not to continue processing under the proprietary number.
BCBSNC will continue to accept HIPAA-defined transactions submitted with a mix of Blue Cross or Blue Shield five-character proprietary provider numbers and NPIs after May 23, 2007 - please register the NPI with BCBSNC quickly.
BCBSNC will continue to accept HIPAA-defined transactions submitted with NPIs only where the NPIs have already been registered with BCBSNC.
BCBSNC will continue to work with providers and trading partners to promote the transition from using proprietary provider numbers to using NPIs on HIPAA-defined transactions.

The date that BCBSNC will no longer accept proprietary provider numbers on HIPAA-defined transactions has not yet been determined, but we do expect that it will not extend past May 23, 2008.

For many months, BCBSNC has been making strong efforts to work with our providers and trading partners to meet the May 23, 2007, compliance deadline. These efforts have included implementing business process and system changes that allow BCBSNC to accept and process HIPAA-defined transactions submitted with NPI. BCBSNC has conducted extensive outreach to the provider community in the form of newsletters, workshops, directly addressed requests for NPI, and direct phone calls to providers. BCBSNC has also worked with healthcare clearinghouses and provider practice management system vendors to promote use of the NPI on HIPAA-defined transactions.

Once our evaluation of the NPI Enforcement Guideline is complete, BCBSNC will finalize our NPI contingency plan. The BCBSNC contingency plan will then be communicated to impacted providers and trading partners. BCBSNC will continue to work towards the goal of full compliance with the NPI regulations.

Provider Conference Presentations

During late summer, Electronic Solutions launched a new format for provider education, The EDI Provider Conference. On two separate days in August, Electronic Solutions sponsored a daylong conference full of EDI content. The conference began with a general session followed by four one-hour workshops covering a wide variety of EDI related topics. Some of the scheduled workshops included presentations from Electronic Solutions, BlueCard, National Provider Identifier, Government Programs (FEP and State PPO), Provider Services, and information on the Blue e Redesign. Health care providers who attended the conferences indicated that they were very satisfied with the new format and content. We are providing copies of the conference presentations in Charlotte and Chapel Hill.

Blue e Hours of Service

Blue e hours of availability are organized by transaction below:

All Inquiries (including Eligibility, Claim Status, Admission Notification)	Seven days per week – 5:00 a.m. to 1:00 a.m.
Claims Transactions	6:00 a.m. to 1:00 a.m. Monday – Friday 7:00 a.m. to 3:00 p.m. Saturday 8:00 a.m. to 12:00 p.m. Sunday

Occasionally, service may be interrupted for system backups or maintenance. To keep inconvenience to users at a minimum, maintenance is performed at the least critical business hours, usually 1–5 a.m. Monday through Friday, or Saturday nights, once a month.

Register your National Provider Identifier (NPI) on Blue e Now!

Part of HIPAA legislation requires the use of National Provider Identifiers on all HIPAA X12 transactions by May 23, 2007. This number will replace all local proprietary numbers, such as the BCBSNC Provider ID, as well as Medicare and Medicaid Provider IDs. Providers should request their new numbers from the CMS enumerator (NPPES) online https://nppes.cms.hhs.gov. Most providers are then required to register their NPI with all payers.

To prepare for this requirement, BCBSNC is collecting our providers’ NPI numbers now. If you are a Blue e user, go to the Blue e Home page, and click on the "NPI Registration" hyperlink to register your NPI with BCBSNC. All providers who submit electronic claims in any format (Blue e or HIPAA transactions) must register their NPI with all payers.

Correct your Professional (837) Claims Electronically

Corrected Professional 837 claims should be submitted electronically using one of the Frequency Type Codes in the 2300 CLM05:3 element that are listed below. Submitting corrected claims electronically improves turn-around time and relieves you of the need to file paper. Remember - electronically corrected 837 Professional claims do not need to be submitted on paper.

Value	Code Title	Definition
5	Late Charges Only	This code is to be used for submitting charges to the payer that were received by the provider after the Admit Through Discharge for the Last Interim Claim has been submitted. However, providers should not use this code in lieu of an Adjustment Claim or a Replacement Claim.
7	Replacement of Prior Claim	This code is to be used when a specific bill has been issued for a specific Provider, Patient, Payer, Insured and "Statement Covers Period" and it needs to be restated in its entirety, except for the same identify information. In using this code the payer is to operate on the principle that the original bill is null and void, and that the information present on this bill represents a complete replacement of the previously issued bill. However, providers should not use this code in lieu of a Late Charge(s) Only Claim.
8	Void/Cancel of Prior Claim	This code reflects the elimination in its entirety of a previously submitted bill for a specific Provider, Patient, Payer, Insured and "statement Covers Period" dates. The provider may wish to follow a Void Bill with a bill containing the correct information when a Payer is unable to process a Replacement to a Prior Claim. The appropriate Frequency Code must be used when submitting the new bill.