NPIs: Avoid Payment Hold-Ups With 'Good Faith Effort' On NPIs

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article discusses National Provider Identifier (NPI) transition issues affecting healthcare practices, especially around referrals, claim submission, and Medicare billing readiness. It focuses on the need for provider outreach, documentation of compliance efforts, contingency planning, and operational preparation for potential electronic claim disruptions. The piece is aimed at providers, practice managers, and compliance staff who needed to understand general NPI implementation guidance and how to reduce payment delays.

Why This Topic Matters

NPI transition problems could disrupt referrals and payment flow if practices were not prepared. The article helps readers understand the broad compliance and operational steps involved in documenting effort, coordinating with referral sources, and planning for possible claim-processing issues.

Article Sections

  1. NPI transition challenges and referral-source readiness

    Introduces the practical problems practices faced when referral sources or payers were not yet aligned with NPI requirements. It also frames the operational impact on claims and billing workflows.

  2. Good faith effort and compliance documentation

    Discusses the importance of documenting outreach and follow-up to support compliance efforts. It emphasizes sustained action, progress tracking, and a structured approach to resolving missing provider information.

  3. Contingency planning and billing readiness

    Covers the role of contingency plans in helping practices maintain payment flow during the transition period. It also addresses readiness for software and claim-processing disruptions and related CMS guidance.

What You Will Learn

  • How NPI transition issues can affect referrals and billing operations
  • Why documentation of compliance efforts matters during implementation periods
  • What contingency planning is intended to support in a practice setting
  • How practices may need to coordinate with referral sources and payers during a transition
  • What operational risks can arise from electronic claim processing during NPI rollout

Who Should Read This

  • Physician practices
  • Practice managers
  • Billing staff
  • Compliance professionals
  • Healthcare administrators

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