Kaiser Permanente NPI billing requirements

In April 2007, the Centers for Medicare and Medicaid Services (CMS) issued guidance related to the implementation of the National Provider Identifier (NPI). CMS allowed entities to invoke a contingency plan aimed at completing any outstanding preparations to fully comply with the NPI mandate no later than May 23, 2008.

Kaiser Permanente’s contingency plan ended May 23, 2008, and we now require an NPI on all standard electronic HIPAA transactions per the mandate.

Kaiser Permanente as a provider

Kaiser Permanente began sending NPIs on all appropriate transactions as of May 2008. Kaiser Permanente will also submit NPI and taxonomy codes into appropriate transactions when and where required by the implementation guides for those transactions.

Kaiser Permanente as a payer

For claims:

• For 837i or 837p electronic claims, Kaiser Permanente will require appropriate NPIs to process the claim. Claims without NPI information will be rejected or denied and the provider should resubmit with the appropriate NPI.
• All CMS 1500 paper claims will require a billing NPI. For Medicare claims, we will also require the same NPI information on paper claims as for electronic.
• All institutional claims, both paper and electronic, will require the HIPAA Health Care Provider Taxonomy Code Set.

Refer to the required fields referenced in CMS 1500 (08/05) Required Fields, UB-04 (CMS-1450) Required Fields, and Claims Payment Reconsideration. For NPI and taxonomy requirements, use our NPI and Taxonomy Requirements grid.

Kaiser Permanente plans to incorporate NPI and the related taxonomy code set into our billing practices to pay your claims as efficiently and accurately as possible.