Providers must attest their NPIs and related data to TMHP by May 23, 2008. Related data includes a taxonomy code, a benefit code (if applicable), and a physical address with a ZIP Code+4. NPIs can be attested on this website. Click here to begin attestation.
Effective May 24, 2008, full NPI compliance will be implemented, and the contingency period will end. Providers that have not attested their NPIs and related data or that do not use their attested NPI and related data will experience rejection or denial of paper and electronic claims, forms, and other transactions. Also, primary care provider panel reports will be closed for noncompliant providers beginning April 1, 2008.
Processing of Paper Claims
Beginning May 24, 2008, all paper claims must use both a Texas Provider Identifier (TPI) and an attested NPI for the billing and performing providers. An NPI is required for all other applicable provider identifier fields.
Processing of Electronic Claims and Other Transactions
Beginning May 24, 2008, all electronic claims and other transactions (e.g., authorizations, eligibility verifications, and claim status inquiries) must use only NPIs.
Batches of electronic claims or transactions that contain any claims with a legacy provider identifier or without an NPI will not be rejected at the batch level. Only the specific claim or transaction with a legacy provider identifier or without an NPI will be rejected.
Electronic Remittance and Status (ER&S) reports will contain only the billing NPI and, when applicable, the benefit code. Paper Remittance and Status (R&S) reports will contain both the NPI and TPI.
Primary Care Provider Panel Reports
Beginning April 1, 2008, TMHP will reassign the clients of any primary care providers (whether enrolled in Primary Care Case Management [PCCM] or any other Medicaid managed care organization) that have not attested their NPI and related data.
For providers with multiple TPIs and with at least one attested TPI, TMHP will transfer the clients from the unattested TPI to the attested TPIif the following criteria are met:
· The attested TPI suffix is credentialed with PCCM as the same type of provider as the unattested TPI suffix.
· The attested TPI suffix has the same physical address as the unattested TPI suffix.
For providers without a TPI to transfer clients to, TMHP will notify the clients to choose a different primary care provider and the provider’s panel report will be closed. TMHP encourages all primary care providers to verify their attestation status.
TDHconnect
TDHconnect does not support NPIs. All electronic transactions will be rejected if they are submitted using TDHconnect. Beginning May 24, 2008, providers must use either TexMedConnect, TMHP’s online replacement for TDHconnect, or third-party billers or software.
Third-Party Billers and Software Vendors
Providers are responsible for ensuring that their third-party biller or software vendor is aware of and complies with the NPI requirements for proper claims adjudication. Third-party billers and software vendors were required to complete the mandatory EDI testing of NPI transactions by December 1, 2007. Providers can review the NPI-Compliant Submitter List, which is available on the EDI webpage on the TMHP website, to verify whether a vendor has completed testing.
If the third-party biller or software vendor has completed testing, providers should work with them to test that everything is working correctly. Providers should submit a small batch of electronic claims using only NPIs. If the claims are accepted for processing, the number of claims in each subsequent batch should be increased until all claims are submitted in the NPI-only format.
Providers can refer their third-party billers and software vendors to the Electronic Data Interchange (EDI) Companion Guides that are available on the EDI webpage of the TMHP website at www.tmhp.com/C5/EDI/default.aspx. Third-party billers and software vendors that have not completed NPI testing at TMHP and want to do so must contact the TMHP EDI Help Desk at 1-888-863-3638.
NPI Dissemination
Effective April 25, 2008, TMHP will verify the NPIs provided during attestation against the National Plan and Provider Enumeration System (NPPES) to ensure that all attested NPIs are active. TMHP will send a notification letter to all providers with NPIs listed as inactive by NPPES. Providers will be allowed a 60-day grace period to contact NPPES and resolve their NPI status. If the inactive NPI has not been reinstated within the 60-day grace period, TMHP will disenroll all TPIs associated with the inactive NPI. TMHP will also close all PCCM panel reports for the disenrolled TPIs. Clients enrolled in these panel reports will be notified to choose a different primary care provider.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. This information will also be published in the 2008 March/April Texas Medicaid Bulletin, No. 214 and the 2008 May CSHCN Services Program Bulletin, No. 66.