WASHINGTON – As expected, the number of rejected claims spiked following the May 23rd deadline requiring all providers to use their National Provider Identifier number on electronic transactions.
Confusion over the actual compliance deadline, hope that the Centers for Medicare and Medicaid Services (CMS) would once again push back the deadline and instances in which providers continued to use their legacy-only numbers were main contributors to the spike, said a CMS official.
Since May 23rd, however, CMS has been seeing “very good progress,” he said. “Most of our contractors are reporting over 90 percent NPI compliance, which is very encouraging.”
Despite initial reports of high volumes of rejected claims from some of the Blues plans within days of the deadline, some regional payers saw little impact.
Horizon Blue Cross Blue Shield of New Jersey collected NPIs from most of its network providers, said spokesman Daniel Emmer.
Some claims-processing delays occurred when Horizon didn’t have NPIs for out-of-network providers, but he said this problem didn’t result in a significant increase in rejections.
“Since the mandate, Horizon BCBSNJ has not experienced a decrease in our first pass rate on clean claims submitted with NPIs,” Emmer reported.
BCBS of Massachusetts began requiring NPIs on claims on March 1st, said Tanya Trombly, director of provider support. The payer did extensive provider outreach to acquire NPIs, crosswalked NPIs to its legacy numbers and educated providers on billing guidelines, as well as working collaboratively with the Massachusetts Health Data Consortium.
“We have experienced NPI-related issues with less than 1 percent of claims,” she said.
BCBS of North Carolina began its NPI collection in 2006 to ensure a smooth transition, said spokesman Lew Borman. “To date, the claims acceptance rate resulting from NPI implementation has not fallen below the normal range for commercial business as a result of the NPI implementation,” he said.
“We are tracking rejections and following up with providers/trading partners when rejects occur,” he said. “We are constantly trying to increase clean claims submitted, NPI was only another opportunity to improve our claims acceptance rates.”
BCBS of Minnesota began processing NPI-only transactions in April 2008, said spokeswoman Jan Hennings. “Blue Cross has been working closely with providers to minimize any business disruption and address specific issues on a case by case basis,” she said.
“The overall impact to Blue Cross’ claim rejection volumes has been minimal and we are pleased with the results to date,” she said.
A number of regional payers who saw a spike in rejected claims are working with their providers to remedy the issue.
Cindy Buckles, director of provider administration for BCBS of Tennessee, said the plan is seeing an increased rejection rate despite “significant enhancements” to its front-end paperless system to capture and validate NPIs in all possible fields.
“Overall, we are satisfied, but we are aware that some providers are still not billing appropriately,” she said.
“We continue to make adjustments to our system and to have an ongoing provider education program detailing the appropriate formats for billing with the NPI,” Buckles said.
BCBS of Florida has also experienced in increase in electronic transaction rejections and internal claims suspends resulting from provider ID issues that are being resolved with no provider impacts, said George Vancore, IT systems integrator for Mandates and Compliance.
The problems, according to Vancore, were outside of BCBSF’s efforts, which included remediation of its electronic transaction portals and internal healthcare business systems capabilities.
“Given the complexity and the NPI implementation and the extensive coordination between multiple electronic trading partners, the overall performance of the NPI implementation is viewed as positive,” he said.
Vancore emphasized that work is ongoing with providers and their trading partners who are still having problems.
The Blue Cross Blue Shield Association has been “actively engaged” in attending to post-May 23rd needs, said Adam Birnbaum, senior manager of Policy at BCBSA. “We regularly communicate with the plans and CMS to help both stay abreast of potential Blue Plan and industry concerns and, when appropriate, serve as the conduit to get questions addressed,” he said.
CMS is also working with contractors and their NPI coordination teams on a daily basis.
“We have 1.5 million providers,” the CMS official noted. “Relatively speaking, we are seeing very few complaints.”
He emphasized that CMS is not insensitive to the financial impact on some individuals. “We are working with our contractors to help individuals who are having problems,” he said.
Still, he said, “we expect progress to continue in a favorable way. The results we are seeing are better than expected.”