National Provider Identifier (NPI)
On April 2, 2007, CMS issued a release clarifying the guidelines for implementation of the National Provider Identifier (NPI) regulations. CMS announced that covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows.
Consequently, Cigna Healthcare's claim processing vendor, Argus Health Systems, will not implement a hard denial on May 23, 2007. At the point of sale, claims will be able to process with either an NPI or NCPDP (NABP) number, or both. However, pharmacies are encouraged to obtain an NPI as soon as possible. Argus Health Systems will continue to take CMS direction regarding the hard cut off date for acceptance of NCPDP number.
Based upon overall industry readiness and continuing efforts toward implementation of the NPI regulations, Cigna HealthCare is requesting that pharmacies continue to use physician DEA numbers when submitting Cigna HealthCare pharmacy claims. This is being requested in an effort to minimize member service disruption starting May 23, 2007.
If a pharmacy claim is submitted with a Qualifier = 01 and a Prescriber NPI, the following claim response will be returned at point of service:
Argus Error Code 034: PRESCRIBER ID IS INVALID
NCPDP Reject Code 25: NON-MATCHED PRESCRIBER ID
The pharmacy should continue to use established prescriber claim submission protocols. In the event that a DEA number is not on file, Cigna HealthCare requests that the pharmacy contact the prescriber and obtain the prescriber's DEA number.
Additional information about claim processing protocols is available in the Pharmacy Payer Sheet, which may be obtained from Argus at www.argushealth.com or at 1.800.522.7487.
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