Premera Blue Cross in Mountainlake Terrace, Wash., has only about 20 percent of the NPIs it will need by next May, said CIO Alan Smit. His staff is also concerned that the federal government has yet to announce whether and when it will provide a bulk file of NPIs to insurers. In addition, Premera's database team can't prepare for the process of validating incoming NPIs because it doesn't know how the government plans to provide verification capabilities, he said.

Premera, which operates in Washington and Alaska, doesn't have to deal with the crosswalking issue because it uses the tax ID numbers of health care providers, which are matched to names and addresses for verification. Instead of having to heavily modify its systems to process a new number attached to every reference to an individual provider, Premera will only have to add another data field to them, Smit said. However, Smit noted that NPI compliance is "a significant effort" that will affect 80 percent of the insurer's systems. He said Premera spent about 10,000 man-hours on the project last year and expects to devote another 30,000 this year as it works to become capable of processing the new IDs by the end of December.

"Like Y2k, I have to go in and add a data element every place where we want to identify a provider," Smit said. In addition to changing the systems used to process claims, Premera has to add a new field to its customer service systems so that when physicians call in to ask about the status of claims, workers can use their NPIs to locate the proper filings.

Katy Henrickson, an analyst at Forrester Research Inc., said that although most insurers have sufficient plans in place to comply by the deadline, unanticipated issues such as how they can collect the NPIs have left many "feeling unprepared." Forrester surveyed eight insurers on NPI compliance issues for a report that the consulting firm issued in May.

Peggy Wiley, senior project manager in the enterprise portfolio management office at The Regence Group, said NPI compliance work is expected to cost the Portland, Ore.-based company a total of $6 million over 30 months. The insurer is made up of Blue Cross and Blue Shield plans that operate in Idaho, Oregon, Utah and parts of Washington.