NPI Contingency Plan

In April 2007, the Centers for Medicare & Medicaid Services (CMS) announced a contingency plan for implementation of the National Provider Identifier (NPI).

Wellmark is continuing to update our applications to ensure compliance with HIPAA regulations. As of May 23, 2007, Wellmark is ready to receive and send NPI transactions.

We know that not all submitters were ready by May 23, 2007. Therefore, to avoid claims processing disruptions, you may submit claims to Wellmark with a legacy number, an NPI, or both. Wellmark will provide notification prior to requiring NPI-only submission.

To ensure appropriate claims processing, please verify the following:

• Format is consistent for the billing and rendering provider number. For example, if the claim is submitted with the billing provider’s NPI and legacy number, the claim must also include the rendering provider’s NPI and legacy number.
• Submitted numbers must be recognized in Wellmark’s system.
• NPI-only will be accepted if you have notified us of your NPI and we have completed updating our system with your NPI. Note: If you have not successfully tested your claims, check your NPI status by contacting Network Administration at 800-708-1342, Option 2.
• NPI-only testing is highly recommended. If you would like to test, contact EC Solutions at 800-407-0267.

Until notified otherwise, TriWest will adjudicate HIPAA-compliant standard electronic transactions (e.g., EDI claims) using one or both of the following:

• Current TRICARE provider identifier (e.g., Unique Physician Identification Number, or UPIN; License number; Medicare identifier; or TEPRV)


• An NPI

Although TriWest will not deny electronic claims without an NPI after May 23, 2007, it’s important to share your NPI as soon as possible with Wellmark. Each week, Wellmark sends TriWest a list of NPIs for providers who are contracted through Wellmark as TRICARE participating providers.

We encourage you to use your NPI today when submitting electronic claims. If you have questions about how to test or use your NPI, please contact Wisconsin Physicians Service (WPI) at 800-782-2680, Option 2.

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