What is the National Provider Identifier?

The National Provider Identifier (NPI) is a unique identification number for use in standard health care transactions. The NPI is a new number that will be issued to health care providers and covered entities that transmit electronic transactions (e.g. electronic claims and eligibility verification) through the National Provider System (NPS). As of May 2005, the National Provider System, an entity established by the federal government, began issuing NPIs to providers that apply and qualify for one.

This identifier, which fulfills a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), must be used by health plans and health care clearinghouses in HIPAA standard electronic transactions by May 23, 2007.

NPIs will replace other provider identifiers previously used by health care providers (and assigned by payers).

NPIs will not replace the tax identification number (TIN) on the HIPAA electronic transactions when used for tax reporting. This applies only to the 837 electronic claim.

What is CIGNA's NPI Collection Strategy?

To reduce the administrative burden on providers, CIGNA plans to collect the NPIs from the CMS National Plan and Provider Enumeration System (NPPES) database and not from individual providers or facilities. The NPPES health care provider data required to be disclosed under the Freedom of Information Act (FOIA) will be made publicly available on August 1, 2007.

What is the CMS guidance on NPI contingency?

On April 2, 2007, CMS released NPI guidance to allow contingency plans to be implemented by covered entities making a good faith effort to comply with the NPI provisions. These contingency plans may include acceptance of legacy provider numbers on HIPAA transactions. Contingency plans may not extend beyond May 23, 2008, but covered entities may elect to end their contingency plans sooner.

The enforcement guidance applies to ALL covered entities (providers, plans, clearinghouses) and to ALL aspects of NPI. In light of this guidance, the CMS announcement does encourage health care providers to obtain their NPIs immediately.

Additional information regarding these guidelines is available on the CMS website. The document, titled "Guidance on Compliance with the HIPAA National Provider Identifier Rule", is available on the CMS website at the following URL under the "downloads" section. http://www.cms.hhs.gov/NationalProvIdentStand

What is the CIGNA HealthCare NPI Contingency plan?

On May 23, 2007, CIGNA began to accept the NPI on HIPAA transactions as described below. It is imperative that Providers follow these recommendations in order to ensure accurate and timely claim payment and EDI responses. CIGNA will also continue to accept HIPAA transactions without the NPI indefinitely. Providers will be notified when CIGNA no longer will accept HIPAA transactions without the NPI.

CIGNA's official NPI Contingency Plan can be viewed here

How to Include NPI on HIPAA Transactions

837 Electronic Claim

• Required data elements such as the Billing Provider Tax Identification Number (TIN), Rendering Provider name and Rendering Provider address must always be included on Professional, Institutional, and Dental claims. Inclusion of this information should not change as a result of NPI implementation.
• When using the NPI to identify the Billing Provider, the TIN must be submitted as the secondary provider identifier. This TIN is the number used on the 1099, which is either the Employer Identification Number (EIN) for organizations or the Social Security Number (SSN) for individuals. Both numbers should not be included. Other identifiers, such as Medicare Provider Number, are considered 'legacy' identifiers as of 5/23/2007 and should not be included.
• Submission of the Billing Provider TIN on the electronic claim is a HIPAA requirement. The National EDI Transaction Set Implementation Guide specifically states the following:
  "If 'code XX - NPI' is used, then either the Employer's Identification Number or the Social Security Number of the provider must be carried in the REF in this loop. The number sent is the one which is used on the 1099."
• All 837 Professional, Institutional, and Dental claims will be accepted with or without the NPI. Dental claims should continue to include the same Rendering Provider information that was required prior to NPI (i.e.: state license number).

270 Eligibility & Benefits Inquiry

• All 270 transactions will be accepted with or without the NPI.

276 Claim Status Inquiry

• 276 transactions should continue to include the TIN to identify the provider.

278 Authorization Request

• 278 transactions should continue to include the TIN to identify the provider. These transactions will be accepted with or without the NPI.

How should I include NPI in my electronic transactions with CIGNA?

Please see the recommendations for each HIPAA transaction above. Your EDI clearinghouse can provide you with additional detailed information about how to submit the NPI on your HIPAA transactions.

What will CIGNA do with standard electronic transactions that are submitted without an NPI?

CIGNA will not reject HIPAA transactions due to the absence of an NPI for an undetermined period after the NPI effective date.

Am I required to submit my NPI on paper transactions?

No. At this time, the NPI mandate applies to only the HIPAA standard electronic transactions.

When will CIGNA allow providers to "dual bill" (send claims showing both our NPI and legacy identifier) to give us the opportunity for trial runs of NPI claims, in case the NPI's don't correctly flow through for payment?

CIGNA does not currently use legacy identifiers to process and pay electronic claims. For this reason, a dual billing scenario is not necessary. For electronic claims submissions, the provider's taxpayer identification number (TIN) will still be required to complete the transaction.

Will CIGNA validate NPI's as part of the claim submission or claim adjudication process?

No. Although the provider is required to submit NPI on the electronic health care claim, the NPI will not be used at this time during the claim adjudication process.

Will CIGNA require an additional number to designate a provider's site of service, in addition to the NPI? For instance, if the provider works at several sites, would you expect the provider to use a site-specific number for each location he works at, in addition to the NPI?

No. The provider's adoption of an NPI will not change any current data elements (such as the provider's TIN, billing name, billing address, etc.) on claims submitted to CIGNA.

Will CIGNA require taxonomy codes to adjudicate claims?

No. Taxonomy codes will not be required for claim adjudication.

Will CIGNA disseminate provider NPI information?

30 days after the NPPES health care provider data becomes available, CIGNA will be capable of sharing the NPI of record with an individual or organizational provider, to confirm NPI information has been received and loaded correctly into CIGNA's system. Providers will need to validate their Tax ID to be eligible to receive this information.

CIGNA will not disseminate the NPI of other health care providers. The NPPES Data Dissemination Notice states: "Entities wishing to obtain the NPI of a health care provider for use in a standard transaction may contact that health care provider directly and request the NPI. Health care providers who are covered entities under HIPAA (known as "covered health care providers") are required by the NPI final rule to disclose their NPIs to any entity that needs them for use in standard transactions."

Will CIGNA's enrollment process change? Will I be required to re-enroll once I obtain my NPI?

No. There will be no changes to the enrollment process, and there is no need to re-enroll once a provider obtains an NPI.

How will CIGNA test NPI submissions with health care providers?

CIGNA will test NPI transactions with EDI vendors and clearinghouses. We will not test NPI submissions directly with health care providers. Health care providers should contact their clearinghouse vendor for more information about including the NPI on their transactions to ensure accurate submissions and reporting.

When will CIGNA start accepting the new CMS-1500 and UB-04 claim forms?

CIGNA will be able to accept the new CMS-1500 claim form when it is available for use by providers on October 1, 2006. Older versions of the form will be accepted until further notice. For information about the new form, please visit www.nucc.org. Details and instructions for using the new form can be found at http://www.nucc.org/images/stories/PDF/instruction_manual.pdf.

Like the CMS-1500, the UB-92, a claim form used to submit institutional claims, is being revised to accommodate the NPI. The National Uniform Billing Committee (NUBC) has released a new version named the UB-04. Older versions of this form will be accepted until further notice. For more details about the form, please visit www.nubc.org.

Where can I go for additional information?

Please contact CIGNA HealthCare Provider Services at 800.88CIGNA (882.4462) or visit CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website for additional information.