National Provider Identifier (NPI) and Taxonomy Codes-Are You Ready?
As previously communicated, AMERIGROUP Community Care (AMERIGROUP) has aligned its implementation date for requiring a valid National Provider Identifier (NPI) and taxonomy code as mandated by the Centers for Medicare and Medicaid Services (CMS) with the Texas State Medicaid Program. The State recently announced that implementation is delayed until May 23,2008.
Therefore, effective on and after May 23,2008, AMERIGROUP will REJECT healthcare claim submissions that do not contain valid NPI and taxonomy code information in the correct locations as delineated in the table on page 2 of this communication. Providers should ensure that their billing software and practice management systems are updated to submit the NPI and taxonomy code information on May 23,2008. More detailed submission information is available in the AMENGROUP NPI Chims Sztbmission Gtlide posted on the AMERIGROUP ASSIST provider portal at http://www.amerigroupcorp.com/providers/. AMERIGROUP must strictly follow these NPI and taxonomy code submission requirements in order to comply with our contractual reporting obligations to the State of Texas for Medicaid (STAR and STAR+PLUS) and CHIP services.
In addition, beginning May 23, 2008, AMERIGROUP will require all paper claims to be submitted on the CMS-1500 (08-05) or the UB-04 claim forms. The claim must be submitted on a red claim form. Copies of the forms will not be accepted. Claims received on or after May 23,2008 submitted on other than the CMS-1500 (08-05) or the UB-04 forms will be rejected and returned to the submitter for resubmission on the new form within the timely filing limit.
Please note that a rejected claim means that the claim is returned to the provider (either electronically for ED1 claim submissions or by mail for paper claims). The claim is NOT recorded in AMERIGROUP's claim processing system and information about a rejected claim does not appear in the AMERIGROUP provider web portal, ASSIST. Also, our Provider Relations representatives do not have access to rejected claim information.
REMINDER: Providers participating in Medicaid products (STAR and STAR+PLUS) must attest to the NPI and taxonomy code information with the State of Texas. If a provider does not complete the attestation process, the provider will no longer be eligible to receive reimbursement from the Texas Medicaid Program including Medicaid Managed Care Organizations. To complete the attestation process, see www.tmhp.com and select the "NPI Announcements" link across the top. If the attestation process is not completed, providers will have to re-apply for participation in the Texas Medicaid Program.
The following table summarizes the basic requirements for NPI and taxonomy code information for claim submissions to AMERIGROUP. Please note that the Texas Provider Identifier @'PI) must continue to be submitted on those claim submissions that have previously required TPI until May 23,2008. The table below delineates the required location of the TPI in italics.
See the Summary NPI & Taxonomy Code Requirements for Healthcare Claims Submissions below.
AmerigroupCommunityCareProviderAlert_021308.pdf