NPPES data dissemination
Welcome to your next issue of the Sage Software eBrief, an update on the latest news, product developments, and tips for bringing your practice into the future with healthcare software. In this issue, you'll find out how National Plan and Provider Enumeration System (NPPES) data will be distributed and what your practice should do to prepare.
Disseminating the data
As part of NPPES, Medicare is making all provider and practice NPI data available to the public. Additionally, Medicare will be using information from the NPPES to adjudicate claims once legacy IDs are no longer used. For these reasons, it's important that you ensure your practice's information in the NPI Registry is correct.
On August 1, 2007, certain pieces of provider information related to NPI registration (e.g. Provider Name, Mailing Address, Taxonomy Code, Provider License Number, etc.) were made available to the general public under the Freedom of Information Act (FOIA). Providers who have been assigned National Provider Identifiers (NPIs) are encouraged to view their NPPES data and to update, change, or delete (where permitted) the data that will be disclosed under the FOIA.
You may have received the Centers for Medicare and Medicaid Services (CMS) notice about this subject. If not, you can read the notice on the CMS website.
Database downloads
- CMS began disseminating data on August 1, 2007.
- NPPES data was made available in an initial file that could be downloaded from the Internet, as well as in a query-only database known as the NPI Registry. Monthly update files will also be downloadable on the CMS website.
- NPIs and related registration information for more than 2.2 million providers are available via this database.
- To be reflected in the initial downloadable file, providers must have submitted updates, changes, and deletions by July 16, 2007.
- Updates, changes, and deletions can still be submitted and will be reflected in the appropriate monthly update file, also downloadable on the Internet.
Common errors in NPPES
- Errors in Employer Identification Number (EIN) – providers that are organizations are required to report the EIN when they apply for an NPI; the EIN may also be the Taxpayer Identification Number (TIN).
- Invalid or incomplete data within the 'Other Provider Identifiers' section of NPPES – this includes the absence of the Medicare legacy number; omission of the 'Type' listed as Medicare for a Medicare provider number; reporting Medicare provider numbers that do not belong to the provider applying for the NPI.
- Reporting an Incomplete Identifier – the full legacy ID, including suffixes, must be reported.
- Having More than the Allowable Number of Legacy Numbers – NPPES can accommodate only 20 'Other Provider Identification Numbers' at this time; in the future, NPPES will accommodate more than 20 identifiers. Providers with more than 20 identifiers should contact their Medicare fee-for-service contractor for assistance.
Need More Information?
For more details on NPPES data dissemination visit the CMS website or read MLN Matters Number SE0725.
Best regards,
Sage Software
