CONSHOHOCKEN, PA – May 23 is hanging over the heads of many payers who have not yet made sufficient preparations for National Provider Identifier compliance. The deadline marks major changes to health plans’ IT and management processes for reimbursing providers.

While NPI is intended to simplify billing procedures on the provider end – each provider will now use only one identifying number when billing payers – health plans will have a harder time adjusting.

“The hype is that NPI was going to be a silver bullet that would streamline a lot of problems for everybody,” said Ned Moore, chief executive of Portico Systems, a vendor of data processing and cross-walking systems. NPI is in fact a much more complex issue, he said. “It touches the heart of every reimbursement process.”    

If a plan has several contracts with one provider, said Moore, the plan will now only receive one number for billing purposes, rather than one number for each contract with that provider. This will mean that many plans will scramble when trying to figure out how to use a single NPI for various kinds of claims.

Paul Hebert, Aetna’s head of provider data services, said Aetna has already made a significant number of changes in anticipation of NPI compliance. “We have upwards of 1.4 million providers, so we’re trying to be as flexible as possible with them,” Hebert said.

While there isn’t time to roll out an enterprise-wide system by May 23, Moore noted, Portico is offering an “end-to-end solution” for NPI compliance. This includes streamlining collection and numeration of each provider’s NPI, supporting plans’ reimbursement processes to include NPI, and building crosswalks between providers and payers.

Robert Booz, research vice president at Gartner, Inc. and author of a report on NPI compliance initiatives, said NPI “Will necessitate an ongoing differential uptake across many internal IT applications and business functions.” Booz recommends that payers establish post-compliance integration beyond crosswalk matching.

Such industry-wide integration will be essential for payers following the deadline, as the industry adjusts to the new standard.

“There are ways we can focus on the claims transactions and make sure that the infrastructure works from day one,” said Moore. “The reality is that it’s a little bit of a heart transplant.”