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Provider IDs

In order to comply with the National Provider Identifier (NPI) regulations within the Health Insurance Portability and Accountability Act (HIPAA), Boston-based Blue Cross Blue Shield of Massachusetts (BCBSMA; $10 billion in revenue) is implementing Portico Systems' (Conshohocken, Pa.) NPI Solution. Created in 2004, the NPI regulations require carriers to assign medical providers a unique nationwide ID number by May 2007 that insurers will use to process claims.

Portico's solution includes a Web-based portal for direct provider submission; a data repository, which includes matching rules, workflows and reports; and an NPI Gateway that enables the integration of the crosswalk with the rest of the enterprise. "We needed an out-of-the-box solution, and Portico Systems offered us an NPI repository, NPI workflow support for entering numbers into the database and other key features to translate NPI into our business rules," says Tanya Trombly, director, provider support, BCBSMA.

BCBSMA began integrating the NPI solution into its EDS (Plano, Texas) claims processing system this summer and hopes to go live with the system by early 2007. --Maria Woehr

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