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NPI Guidelines Effective May 23, 2008, all providers covered by HIPAA, including physicians, dentists, pharmacists, hospitals, nursing homes and medical groups who transmit health information electronically are required to use their National Provider Identifier (NPI) on electronic claims and other transactions. This applies to all 837 transactions, whether submitted through a clearinghouse or via direct submission. If claims and other electronic forms are submitted without a Billing Provider NPI on or after May 23, 2008, they will be rejected. Providers will then be required to correct and resubmit documents. When appropriate, a Rendering Provider NPI will be required if different than the Billing Provider NPI. Affinity will accept, and prefers to receive, dual file submissions (those containing both NPI and legacy IDs). Please note that until June 23, 2008, we will accept claims that contain non-matching NPI numbers (NPI numbers submitted on claims that do not match the NPI numbers in our system). If you have a non-matching NPI number, we will indicate this error on your Explanation of Payment (EOP) report. You will need to fax your correct NPI number to us as soon as possible. After June 23, we will reject claims that contain non-matching NPI numbers. Please refer to the technical specifications below for more details. How to Report your NPI to Affinity If you have already obtained your NPI from the National Plan and Provider Enumeration System (NPPES) and have not yet advised Affinity, please provide us with this information. You may do so by contacting your provider relations representative or by completing the Affinity Provider NPI Information Sheet and faxing it to 718.794.7808. Upon receipt of your NPI information, we will update our system within 3 business days. Also, be sure to advise your software vendor, billing service and/or clearinghouse of your NPI. How to Apply for an NPI Health care providers can apply for their NPI online, by phone or mail:
For More NPI Information The Web sites listed below provide additional NPI information. If you have any questions, please contact Customer Service at 866.247.5678, Monday through Friday from 8:00 a.m. to 8:00 p.m., and on Saturdays from 9:00 a.m. to 3:00 p.m. NPI-Related Technical Specifications Electronic Submissions NPIs must be reported within the appropriate provider loops on all electronic transactions submitted to Affinity Health Plan:
Dual File Submissions Affinity prefers to receive submissions containing both NPI and legacy IDs. For these submissions, please include your Affinity legacy information as follows:
Paper Claim Submissions The NPI should be displayed as follows:
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