NPI contingency plan

Fallon Health is prepared to accept and send the National Provider Identifier (NPI) in electronic transactions as of May 23, 2007, as required under the regulations imposed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Fallon recognizes that some of our provider partners who are actively working toward compliance will not meet the May 23, 2007, deadline. As a result, Fallon will continue to accept legacy provider numbers beyond May 23, 2007, from existing provider partners who are currently testing with Fallon or have submitted a written plan which outlines the date they will be able to begin testing. This contingency plan applies only to existing provider partners submitting electronic transactions. After May 23, 2008, Fallon will only accept the NPI numbers.

Fallon is committed to working with providers to become fully compliant and will look to the Centers for Medicare & Medicaid Services for additional guidance in amending our contingency plan moving forward.

If you have any questions regarding testing, please contact the EDI Coordination Unit at 1-866-275-3247, option 6. For all other questions, please contact Provider Relations at 1-866-275-3247.