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NPI
Readiness of the Chain
  Pharmacy Industry

          January 24, 2007
          Michele M. Vilaret, RPh
Director of Telecommunications Standards




                                           1
Issues
Enumeration
Prescriber IDs
Readiness of Industry
Processing of Claims
Implementation Dates




                        2
Enumeration
92% of all chain pharmacy have obtained
NPIs through NCPDP
Other 8 % have been identified
– Small chains could have enumerated on own
– NCPDP trying to add to database
Concern that all processors have NPIs
loaded
Confusion with taxonomy codes

                                              3
Prescriber IDs
Obtaining Prescriber IDs
– Not feasible to call
    Number must be Valid
– Standardized files
    Format of files
    Sharing of files
– Not all prescribers will have an ID
    Ensure prescribers obtain IDs
– Need dissemination guidance from CMS

                                         4
Readiness of Industry
Testing
– Approximately 75% of NACDS members
  surveyed have tested
Submission of claims
– No NACDS members are currently submitting
  claims
– Most are able to submit claims
– 50% of NACDS members are able to submit
  reversals at this time
                                              5
Claims Processing
Pharmacies process 4 billion claims on-line
annually
Service delays could be overwhelming
Should roll out gradually
Adjudicate claims using DEA, state license
number or NPI number for several months
…….soft edit
Message back the NPI when on file
Monitor integrity of data during this period of
time before hard edits put into place.


                                                  6
Implementation Date
May 23, 2007
Lack of payer sheets
Feasibility of date
– Plans implementing prior to this date with
  hard cut-over…e.g. DE Medicaid
Need time to obtain prescriber numbers
and add to system and maintain integrity
of the data

                                               7
Thank You




            8

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Ncvhs Testimony 012707

  • 1. NPI Readiness of the Chain Pharmacy Industry January 24, 2007 Michele M. Vilaret, RPh Director of Telecommunications Standards 1
  • 2. Issues Enumeration Prescriber IDs Readiness of Industry Processing of Claims Implementation Dates 2
  • 3. Enumeration 92% of all chain pharmacy have obtained NPIs through NCPDP Other 8 % have been identified – Small chains could have enumerated on own – NCPDP trying to add to database Concern that all processors have NPIs loaded Confusion with taxonomy codes 3
  • 4. Prescriber IDs Obtaining Prescriber IDs – Not feasible to call Number must be Valid – Standardized files Format of files Sharing of files – Not all prescribers will have an ID Ensure prescribers obtain IDs – Need dissemination guidance from CMS 4
  • 5. Readiness of Industry Testing – Approximately 75% of NACDS members surveyed have tested Submission of claims – No NACDS members are currently submitting claims – Most are able to submit claims – 50% of NACDS members are able to submit reversals at this time 5
  • 6. Claims Processing Pharmacies process 4 billion claims on-line annually Service delays could be overwhelming Should roll out gradually Adjudicate claims using DEA, state license number or NPI number for several months …….soft edit Message back the NPI when on file Monitor integrity of data during this period of time before hard edits put into place. 6
  • 7. Implementation Date May 23, 2007 Lack of payer sheets Feasibility of date – Plans implementing prior to this date with hard cut-over…e.g. DE Medicaid Need time to obtain prescriber numbers and add to system and maintain integrity of the data 7