Psychotherapy
Finances

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Volume 33, No. 1, Issue 393January, 2007


MANAGED CARE: NPI numbers will be required by ValueOptions; new forms needed

The way business is done with managed care is changing. Starting May 23, ValueOptions will require its network clinicians to have a National Provider Identifier (NPI) issued by the Centers for Medicare and Medicaid Services (CMS). You’ll need this to get reimbursed--even if you don’t file claims electronically.

Are other companies following suit? Not quite yet, though it seems to be coming. When we checked in with a selection of other big companies, we found that most offered a similar line: soon but not yet. An Aetna spokesperson says network members “are encouraged to use an NPI, but won’t be required to do so.” The same is true for CIGNA, MHN, Ceridian.

For now, Magellan, the nation’s top behavioral health MCO, plans to continue taking paper claims without NPIs. But that policy could change soon, says spokeswoman Christina Carroll.

“Really, everybody needs to apply for these things,” she says. “Today, [paper claims without an NPI] will be paid, but I can’t guarantee it’s going to be that way forever. It will likely be a grandfathering process.”

How do you get an NPI? Go here: https://nppes.cms.hhs.gov/NPPES/Welcome.do.   Also note, the HCFA 1500 form is passing out of use, to be replaced by a new “CMS 1500” which has a blank for the NPI. (We’ll be looking at Medicare trends, including the NPI issue, in next month’s PsyFin.

Susan Frager, a professional biller and managed care consultant based in Lacey, WA, predicts a “significant claims slowdown” as managed care transitions to the NPI. She also believes that with the trend toward Web-based administration, the days of avoiding HIPAA “may be over.”

“People say they don’t file electronic claims. But the way HIPAA is, if you ever go online to check authorization you’re going to be subject to HIPAA. You’re using health care information in an electronic transaction.”

But obtaining an NPI won’t in itself make you a HIPAA covered entity, says Jean Thoensen, a biller from Centreville, VA. “That’s a myth,” she emphasizes. Getting your number is a risk-free transaction.

On her Web site, Thoensen offers a page of software resources for clinicians. You can fill out a CMS 1500 online and print out the completed form. See www.psychbiller.com/resources/index.php.

You can also get the new form for free at the CMS Web site: http://www.nucc.org/images/stories/PDF/cms_1500_sample.pdf. But at the CMS site, you can’t work with the form online without additional software. You’ll have to print it, and fill it out by hand.

Handwritten paper claims are a part of the business that managed care has been working hard to reduce. United Behavioral Health announced late last year that it wouldn’t take handwritten claims--but then it backed off and said they wouldn’t be rejected automatically.

Magellan continues to manually process all paper claims. They complain, however, that staff has to spend time puzzling over whether a digit is an 8 or a 0. “Over the years it’s gotten much, much better,” Carroll adds. “There was a time when we would get claims submitted on a cocktail napkin. It was like, ‘Come on people, this is a business.’”

Contacts: 1) Tina Carroll, Magellan, St. Louis, MO, (314) 387-5345; 2) Susan Frager, Lacey, WA, (360) 628-8612, email: susan@psychadminpartners.com; 3) Jean Thoensen, Centreville, VA (703) 266-8612, email: info@psychbiller.com.