CMS Relaxes NPI Deadline

The Centers for Medicare & Medicaid Services (CMS) has just announced that it is relaxing the enforcement of its May 23, 2007 deadline concerning the mandatory use of the National Provider Identifier (“NPI”) in conjunction with all standard transactions.

Section 1173(b) of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) set into motion the events that led the Secretary of Health and Human Services to create the NPI. Originally, CMS announced that each provider would be required to use an NPI as his or her primary identifier in all standard transactions, including eligibility verification, HCFA claim submission and electronic claim submission. Under the original rules, failure to do so after May 23, 2007 would result in denial of all claims and requests for eligibility verification.

In its latest NPI announcement, CMS Acting Administrator Leslie Norwalk, Esq., explained the following: “The enforcement guidance released today clarifies that covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows.”

During this one year period, CMS will not initiate enforcement actions for failure to use NPIs in standard transactions. However, while CMS and commercial payers are permitted to accept claims that do not contain NPIs, it is unclear whether all payers will voluntarily relax the deadline across the board for all providers. In fact, health plans are required to “continue to work towards compliance” so a provider should not assume that he or she has another year to obtain an NPI.

In the end, CMS has made it clear that many providers and health plans are having difficulty meeting the May 23, 2007 deadline and has indicated a willingness to temporarily forgo enforcement. Notwithstanding this temporary reprieve, in view of the ease of obtaining an NPI and the uncertainty surrounding the necessity of using same, each provider should ensure that he or she has an NPI to apply for an NP click here prior to May 23, 2007 and should immediately start using the NPI in all standard transactions.

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