Title
Public Health Department recommending the Board grant the Directors of Public Health, Mental Health, Human Services, and all other applicable departments the authority to apply, or designate staff to process web-based National Provider Identifier (NPI) applications on behalf of the County and subpart NPIs for each department, noting each department will determine the number of NPIs based on department needs, billing numbers, and business practices.
RECOMMENDED ACTION: Approve.
FUNDING: N/A
Body
Fiscal Impact/Change to Net County Cost: There is no fiscal impact or net County cost.
Background: The Health Insurance Portability & Accountability Act (45CFR162.420) requires covered entities implement the NPI as the standard unique health provider identifier for use in health care systems. The NPI will replace health plan identifiers (e.g., Medicare, Medi-Cal, and private health plans numbers) used in connection with standard transactions.
According to 45 CFR ยง162.420, a covered health care provider must obtain an NPI for itself or for any subpart of the covered entity that would be a covered health care provider if it were a separate legal entity. As a single legal entity, El Dorado County will receive one organizational NPI and each department will determine additional subpart NPIs (as part of the legal entity).
Reason for Recommendation: The NPI must be used in standard transactions such as health claims, health encounter information, health claims attachments, health plan enrollments and disenrollments, health plan eligibility, health care payment and remittance advice, health plan premium payments, first report of injury, health claims status, and referral certification and authorization. All entities meeting the NPI definition must obtain a NPI by May 23, 2007 or possibly have their billing process disrupted.
Each covered legal entity that provides health care services is eligible to receive an NPI. Subpart (parts of the legal entity) NPI numbers are needed in order to identify specific programs, departments, licensure, locations, and/or classifications for billing. Each County department will determine the number of subpart NPIs needed based on the department needs, billing numbers, and business practices.
According to the Centers for Medicare and Medicaid Services (CMS), use of the web-based application process results in the most efficient application processing and the fastest receipt of NPIs. Therefore, in order to process the NPI applications and receive NPI numbers quickly, the department recommends utilizing the web-based process.
Action to be taken following Board approval: The Director of Public Health will authorize the Privacy/Compliance Officer to apply electronically for El Dorado County's NPI number and designate staff to apply for subsequent subpart NPIs. The Directors of Mental Health, Human Services (if needed), and all other County departments to whom this is applicable, or their designee(s), will apply and process web-based subpart NPI applications.
Contact: Dan Buffalo
Concurrences: