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NPI FAQs About CareFirst/CareFirst BlueChoice
1. Should I notify CareFirst/CareFirst BlueChoice when I obtain my NPI?
Yes. Providers should send us their NPI as soon as it is received. We are adding NPI information to our records and will link the NPI to your legacy ID (your provider ID number(s) assigned by CareFirst/CareFirst BlueChoice). NPIs cannot be extracted from claims. As a result, you must submit your NPI information directly to our Provider Information & Credentialing Department. Also, be sure to share your NPI with other health care providers (and payers) with whom you do business.
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2. How should I send my NPI number(s) to CareFirst and CareFirst BlueChoice?
We will accept NPI numbers from providers in a variety of formats:
- Complete the online NPI Submission form. Follow the directions provided online to either submit the information electronically, or print and fax it to CareFirst/CareFirst BlueChoice.
- If you have a standard form that you would like to send, please be sure you have the data elements requested in the NPI Submission Form. For a copy of the Submission form, please contact Provider Services or refer to the January/February 2007 BlueLink for a list of fields that must be included in your spreadsheet. You can send your own spreadsheet to CareFirst/CareFirst BlueChoice by fax to 410-505-2959 or by mail to:
CareFirst BlueCross BlueShield/CareFirst BlueChoice, Inc.
Provider Information and Credentialing
10455 Mill Run Circle
PO Box 825
Owings Mills, MD 21117
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3. On the online NPI Submission form, what is the difference between a group practice and a facility?
A facility is a location that offers inpatient and outpatient services which are usually billed on a UB claim form. A group practice is an association of health care professionals who share premises and other resources and usually submit claims using a CMS 1500 claim form.
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4. Why do I need to send my Social Security number on the NPI submission form? If CareFirst has my Tax ID, why do they need my Social Security number?
A provider’s Social Security number is just another one of the data elements we are using to verify that the NPI submitted is linked to the appropriate legacy provider ID number for the purpose of our crosswalk and our provider files.
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5. Why didn’t I receive a confirmation number when I submitted the online NPI Submission form?
If you did not receive a confirmation number for your online submission, it is because you selected the “Print only” option. You can simply fax your printed copy to 410-505-2959 or mail a copy to:
CareFirst BlueCross BlueShield/CareFirst BlueChoice, Inc.
Provider Information and Credentialing
10455 Mill Run Circle
PO Box 825
Owings Mills, MD 21117
You will receive confirmation via e-mail or mail that we have received your NPI information.
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6. I have a question about completing the online NPI submission form. What should I do?
Please contact our Provider Information & Credentialing Department at 410-872-3500 for any questions related to the online NPI Submission form.
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7. Will CareFirst and CareFirst BlueChoice share my NPI with other Blues plans?
No. CareFirst and CareFirst BlueChoice cannot share your NPI with other Blues plans because the NPI is a unique identifier assigned by CMS to each provider. The NPI is not assigned by CareFirst/CareFirst BlueChoice therefore we do not have the authority to share it with other carriers, and providers. It is the responsibility of the provider to share their NPI with health plans and other providers with whom they do business.
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8. How will you notify providers once you have received their NPI?
CareFirst and CareFirst BlueChoice will send confirmation via fax, e-mail or mail after your NPI submission has been reviewed, verified and added into our systems. Please be patient through this process, as we are experiencing extremely large volumes of duplicate data and submission requests. Also, please do not submit your NPI information more than once.
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9. Why haven’t I received confirmation from CareFirst/CareFirst BlueChoice that they have my NPI information?
Rather then send confirmation upon receipt of your NPI number, CareFirst and CareFirst BlueChoice will review, verify and add your NPI information to our records. It may take up to 90 days after your NPI submission to receive a confirmation. We appreciate your patience during this process. Please do not submit your NPI information more than once. We will contact you if additional information is required to include your NPI in our systems.
In addition, CareFirst and CareFirst BlueChoice experienced a system error on the NPI submission form. If you used the online form and selected the “Submit” option, please check the printed copy of your form for the date and time stamp on the right-hand side of the page. If your date and time falls between 7:15 p.m. on March 23 and 3 p.m. on April 3rd, or if the first 5 digits of your confirmation number start with 07083 through 07092, please resend your NPI information. If you do not have a printed copy of your online submission form, you should resend your information. No other NPI submissions were affected by this system error. We apologize for any inconvenience.
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10. How can I submit corrections to my NPI Submission form?
If you have corrections to your NPI submission form, you may send an e-mail to NPI@CareFirst.com with “NPI Correction” in the subject line. If you do not have Internet access, please call Provider Information & Credentialing at 410-872-3500 or 877-269-9593. You may also submit another NPI Submission form with “NPI Correction” across the top of the form. In either case, it is important to highlight the corrected information, such as “Corrected Provider NPI Number.”
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11. Should I continue to use legacy or proprietary ID numbers on claims and inquiries?
CareFirst and CareFirst BlueChoice require the provider's legacy ID number, along with the NPI as a contingency to avoid delay in claim and inquiry processing. For electronic transactions, this is considered a “dual use” approach. For more information, please refer to our NPI Dual Use Comparison Guide.
In addition, CareFirst/CareFirst BlueChoice will require legacy provider ID numbers on paper claims, referrals and when accessing the BlueLine and FirstLine VRUs, CareFirst Direct, iExchange and IASH.
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12. After May 23, 2007, should we send the NPI on paper claims?
Providers are encouraged to use the current CMS 1500 (12/90) version of the professional claim form and the UB-92 version of the institutional claim form. By doing so, you will submit paper claims with a legacy ID number, as you currently do.
We will accept the CMS 1500 (08/05) and UB-04 versions of the paper claim forms. If you choose to use the new claim forms, you must still submit using your legacy ID number. The use of NPI will be optional.
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13. When will CareFirst/CareFirst BlueChoice begin to accept NPI numbers on electronic claims?
Currently, providers may submit 837 electronic claims with their NPI when submitted with your current provider ID number(s). This is considered a “dual-use” period and will be in place until further notice.
For more information, please refer to our NPI Dual Use Companion Guide.
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14. When can we send electronic claims with only the NPI number and not the legacy IDs?
As you may know, the Centers for Medicare and Medicaid Services (CMS) recently announced that health plans may implement contingency plans to ensure smooth payment cycles to providers while working reasonably and diligently toward full compliance for up to 12-months after the May 23, 2007 NPI compliance date.
As part of our contingency plan, CareFirst and CareFirst BlueChoice will require legacy ID numbers on 837 electronic claims after May 23, 2007. We are unsure at this time how long the contingency plan will be in place, so please continue to submit legacy ID numbers until further notice. The NPI will remain optional.
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15. If I send my NPI only on 837 electronic claims during the dual use period, what will occur?
Claims submitted with NPI only may result in delayed claims payment because CareFirst/CareFirst BlueChoice will need to determine your legacy ID number prior to processing your claim.
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16. Will CareFirst/CareFirst BlueChoice test claims processing using the NPI number? When will such testing begin?
Testing for 837 and 835 transactions started in October 2006 with those EDI clearinghouses that were ready. Electronic claim vendors should be testing 837 claim submissions with CareFirst/CareFirst BlueChoice now. . Please check with your vendor/clearinghouse to ensure they are currently testing this process on your behalf.
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17. Are you developing a crosswalk?
Yes, a crosswalk is being developed that will link the provider’s Type 1 and/or Type 2 NPI number to the appropriate legacy number for claims processing. This process will convert the legacy number back to the NPI number for outbound electronic transactions. Data elements being evaluated in the crosswalk are billing and rendering NPI, taxonomy code, tax ID, pay-to/billing address, service facility location address, and provider name.
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18. Should I continue to use legacy provider numbers for certain functions (e.g., VRU, paper claims, referrals)?
After May 23, 2007, providers must continue to use their legacy provider number when accessing the BlueLine and FirstLine VRUs, CareFirst Direct, iExchange and IASH. Also for paper claims and referrals, CareFirst will require legacy provider numbers. NPI numbers on paper claims will remain optional, because it will not be used for paper claim processing at this time. For electronic claims, continue to send legacy numbers for rendering and referring physicians.
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19. Does submitting a claim with an NPI guarantee payment from a health plan?
No. An NPI number is an identifier but it does not indicate a contractual relationship between the provider and health plan. Providers who wish to participate with CareFirst and/or CareFirst BlueChoice can find information in the Credentialing section of our Web site.
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20. Who can we contact if we have additional questions about how CareFirst and CareFirst BlueChoice will handle the NPI?
Please send your questions via email to NPI@CareFirst.com.
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21. Our organization has a delegated credentialing arrangement with CareFirst and CareFirst BlueChoice. Do you expect to receive the NPI number on forms currently sent to CareFirst and CareFirst BlueChoice?
CareFirst and CareFirst BlueChoice will need to receive the NPI number for all providers and practitioners irrespective of credentialing processes.
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