Feds say plans can soften deadline for doctors' universal ID numbers

Medicare and some insurers might allow physicians to use either their new National Provider Identifiers or older IDs on claims after the May target date.

By David Glendinning, AMNews staff. April 23/30, 2007.

Washington -- The federal government has given the health care industry up to a year-long reprieve in adopting a new standard identification system for use on electronic claims. But that doesn't necessarily let doctors off the hook when it comes to obtaining and using the new ID numbers.

Under a mandate from Congress, the Centers for Medicare & Medicaid Services established May 23 as the deadline for physicians and other medical professionals to apply for and start using a unique National Provider Identifier on all electronic claims. The 10-digit NPI, designed to replace all other identifiers, is required for anyone who files claims electronically with Medicare or any other payer. This applies even if the physician uses an outside firm that files electronically on his or her behalf.

CMS recently came to the conclusion that too few health plans, doctors and others would be ready to use the NPI in place of all existing IDs, known as "legacy" identifiers, by the May deadline. Small health plans already have until May 2008 to comply, but the agency decided that many other large payers and health professionals also would need more time to get up to speed. Numerous industry organizations, including the American Medical Association, lobbied the government to soften the deadline.

So for the 12 months after the May 23 deadline, CMS will allow payers to process claims using either NPIs or older ID numbers without penalty, as long as the insurers have adopted appropriate contingency plans for moving to an NPI-only system. Physicians who are not ready to use their new numbers on all claims would benefit from this contingency period only if the payers they deal with decide to take advantage of the extra time.