National Provider Identifier (NPI) at Mercy Care Plan

Centers for Medicare & Medicaid Services (CMS) has announced that the National Provider Identifier (NPI) will become the standard, unique identifier for all health care providers by May 23, 2007. It will eliminate the need for providers to track and use multiple identifiers assigned to them by health plans and other payors. On May 23, 2005, providers can begin to apply for their individual NPI. Please refer to the website https://nppes.cms.hhs.gov for information on how to apply for your NPI.

If you are not familiar with NPI, you can obtain more information from the CMS website:

http://www.cms.hhs.gov/hipaa/hipaa2/regulations/identifiers/default.asp

Mercy Care Plan (MCP) is prepared to accept and store NPI received from participating providers. MCP is also able to use the NPI in any electronic claim transmissions as required by CMS. Please communicate your NPI in writing directly to the MCP Provider Services Department as soon as you obtain one.

While MCP is working closely with AHCCCS to understand how they will convert your AHCCCS ID numbers to NPI, it is critical that you continue to provide to MCP your current AHCCCS ID on all electronic and paper claims until further notice in addition to using your NPI.

If you submit claims electronically through EDI, please work with your vendor to ensure that your NPI is placed in NM109 using the Identification Code Qualifier of 'XX' in NM108, and your AHCCCS ID is placed in REF02 using the appropriate Identification Code Qualifier in REF01 within the Secondary Identifier segment.

Until the UB-92 and HCFA forms are updated to accommodate NPI, we ask that you document your NPI in Box 11 of the UB-92 form, or Box 19 of the HCFA 1500 form. To avoid confusion, please do not place the NPI in the same box as your AHCCCS ID.

Should you have any questions, please contact your Mercy Care Plan Provider Services Representative at (602) 263-3000 or toll-free at 1-800-624-3879.