Mandate Compliance

NASCO monitors and implements required federal mandates that affect Plan operations. Our staff stays up-to-the-minute on mandates that are in process as well as those that have passed. The goal is to ensure Plan compliance in addition to assuring that the processing system continues to successfully perform with minimal Plan impact. Our leadership in identifying and delivering holistic solutions, making sure that a Plan’s local solution fits with the national solution, has been demonstrated in past initiatives like HIPAA and SSN USA. Regarding SSN USA, Laura Marble, Vice President of Auto, National Systems and Support at BlueCross BlueShield of Michigan stated, “This project should be the standard to which all projects should be held. It was well managed for both time and budget, and was a true collaboration between NASCO and the Plans.”

National Provider Identifier (NPI)

The compliance date for exclusive use of CMS-assigned NPI in standard transaction interfaces between providers and large health plans is May 23, 2007. Use of the NPI will reduce costs, improve the efficiency of the nation’s healthcare system, and eliminate the need for healthcare providers to maintain, keep track of, and use multiple identification numbers assigned by the various health plans they bill.

UB04 - CMS 1500

Early in 2005, the National Uniform Billing Committee (NUBC) published mandated updates to the UB92 paper claim form, creating the UB04 format for facility (institutional services) paper claims. All health plans and vendors must be prepared to use the updated UB forms by March 1, 2007.

CMS 1500 is controlled by the National Uniform Claim Committee (NUCC) and is an update for professional service paper claim forms. The forms’ content is the basis for NPS online claims entry screens, and using them will better align Plans with HIPAA electronic claims requirements, and help ensure efficient processing of those claims. All health Plans and vendors must be able to accept the updated CMS 1500 formats by May 23, 2007.