Group Health Cooperative Health Plan Administration East Marginal Way by pluggtwo


									                                                                      Group Health Cooperative
                                                                      Health Plan Administration
                                                                      12400 East Marginal Way South
                                                                      Tukwila, WA 98168-2559


July 9, 2007

                Updates on the CMS 1500 Claim Form and NPI

Group Health extends deadline for submitting “old” CMS-1500 form
Medicare recently announced that it will accept only the new CMS-1500 form (08/05) beginning
July 1, 2007. Medicare also stated that it will return any “old” (12/90) versions of the form
received after Friday, June 29, 2007 (the last business day of June).

Due to late notification of this decision from Medicare, Group Health will continue
accepting either the new (08/05) or the old (12/90) version of the CMS-1500 form until
September 14, 2007. After that date, Group Health will also return claims submitted on
the old form.

CMS to publish NPI data on Internet
The Centers for Medicare and Medicaid Services (CMS) plan to post on the Internet provider
NPI data from the National Plan and Provider Enumeration System (NPPES) database. NPI data
elements are subject to disclosure under the Freedom of Information Act (FOIA) with the
exception of such sensitive information as Social Security numbers and dates of birth.

CMS will make the database available starting August 1, 2007. Group Health is encouraging
its providers to follow CMS’s recommendation to review and update NPI information by
July 16. In addition to making corrections, providers may choose to exclude any information that
CMS has designated as “optional.”

For more information about NPI data disseminationincluding a list of the data elements, and
instructions on how to update your informationplease go to
_062007.pdf, or call the enumerator (NPPES) at 1-800-465-3203.
Group Health continues its NPI contingency plan
Group Health has not yet set a date for ending its NPI contingency plan. Providers may continue
to submit claims with NPIs and/or legacy identifiers. Group Health will give providers at least 60
days notice before changing this plan.

If your organization is now billing with NPIs, please remember that the NPI does not replace
other required data elements on your claims (such as entity names and addresses). We also
encourage you to include taxonomy codes wherever applicable.

Need assistance?
If you need assistance or have questions about these or other Group Health initiatives, please use
one of these resources:
       Go to our Web site On the home page you will find links to a variety of
       NPI-related information. If you are not registered with OneHealthPort, click “For
       Contracted Providers” (lower left of page), then click “NPI” from the log-in page.
       E-mail us at
       Call the Group Health Provider Assistance Unit at 1-888-767-4670.


Joel Suelzle
Vice President
Health Plan Administration and Provider Contracting

To top