1. When and how will you begin collecting provider NPIs?

First Health is already collecting NPIs from providers. The provider applications used by First Health have a place for providers to enter their NPI. If the NPI is provided on the provider application, then it is entered into First Health’s Provider Database when the application is processed. Existing providers do not have to complete a new application to supply us the NPI number. You may contact your Provider Representative directly to update your NPI. We will also receive your NPI if you submit your provider information through the CAQH Universal Credentialing Datasource (UCD).

2. How and when will you communicate your NPI implementation plan?

For information about First Health’s NPI implementation plan, go to www.firsthealth.com, click on the link on the left hand side “Network Services Online”. Then look under the “What’s New” section in the upper right hand corner of the web page.

3. Will you update your companion guides?

First Health does not currently provide its own companion guides for HIPAA transactions. First Health follows the standard HIPAA transaction implementation guides published by Washington Publishing Company (www.wpc-edi.com).

4. For hospital providers, where you have previously required multiple PINs for special programs or clinics (i.e., psychiatry and substance abuse), will you be able to use the main hospital NPI?

The answer depends on the way in which the facility is contracted with First Health. It is our assumption that facilities will acquire subpart NPIs in the same manner that bill today; however, we understand this is not a requirement. We will need to be informed of all NPI and subpart NPIs. If your facility is only going to obtain one main NPI and you require or your contract requires payment to different facilities under the one Tax ID, then First Health may require a taxonomy code on these claims. Please work with provider relations to review your setup in our system and your NPI strategy.

5. Do you plan to test the claim submission and adjudication process?

Yes. Claim submission tested with First Health has already taken place. We do not need to test with individual facilities or providers. Claim adjudication testing based on NPI numbers is ongoing.

6. How will you validate submitted NPIs?

First Health’s Provider Database ensures that each NPI entered is unique and that it is assigned to a single provider. First Health also verifies that the NPI is a valid CMS generated number, by applying the CMS check digit verification logic when NPIs are entered into our Provider Database. For those providers already in the First Health Provider Database that fail this check the health plan will contact the provider to correct this information.

7. Will taxonomy codes be required to adjudicate claims once the NPI is implemented?

They will not be generally required. There may be some specific situations that First Health will require a taxonomy if your NPI subparting strategy does not match up with how your contract is administered. This situation should be limited.

8. Will you require the NPI on paper claims?

First Health will accept the NPI on paper claims and encourages its providers to enter the NPI on all paper claims. After May 23, 2007, First Health does not expect to reject or deny paper claims with legacy identifiers. As of 10/1/06, we are able to accept the New HCFA 1500 claim forms that provide a location for both the NPI and the legacy number. We will also be ready to accept the new UB-04 claim form in early 2007.

9. Will you require the referring physician NPI to adjudicate claims?

No.

10. What is your time frame for sending the NPI on the 835 transaction?

By the compliance date of May 23, 2007.

11. Will there be differences depending on insurance product or claim adjudication system?

Not at this time.

12. How do you plan to do 835 acceptance testing?

To be determined.