 |
|
What is NPI?
On January 23, 2004 the Centers for Medicare & Medicaid Services (CMS) published the final rule for the National Provider Identifier (NPI). The rule establishes a standard for using a nationally assigned NPI that will be required for all electronic health care transactions. It is one provision of the Administrative Simplification portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
What is the purpose of NPI?
The NPI is a single identification number that will be assigned by the federal government to health care providers. It is intended to improve the efficiency of the health care system and help to reduce fraud and abuse. Implementation of the NPI will eliminate the need for health care providers to use different identification numbers when conducting HIPAA standard transactions with multiple health plans.
Who gets a National Provider Identifier (NPI)?
NPIs will be assigned to health care providers who need them to submit claims or conduct other transactions specified by HIPAA. A "health care provider" is defined as an individual, group, or organization that provides medical or other health services or supplies. This includes:
|  | physicians and other practitioners |
| | physician/practitioner groups |
| | institutions such as hospitals |
| | laboratories |
| | nursing homes |
| | dental providers |
| | suppliers such as pharmacies and medical supply companies and |
| | any health care provider who transmits any health information in electronic form in connection with a standard transaction. |
Exception: Health industry workers, such as admissions and billing personnel, housekeeping staff, and orderlies who support the provision of health care are not eligible to obtain NPIs.
What will the NPI look like?
The NPI will be a ten digit numeric field that will include one check digit in the tenth position to ensure accuracy. This format will permit 200 billion unique identifiers to be issued without reusing the same values. The NPI will contain NO imbedded intelligence. In other words, you will not be able to determine a provider's state, region, specialty or any other information directly from their NPI.
How does a provider get an NPI?
NPIs will be issued by the National Plan and Provider Enumeration System (NPPES). A provider may apply for an NPI in one of three ways:
| | Beginning July 1, 2005, a provider may prepare a paper application and send it to the entity that will be assigning the NPI (the Enumerator). A copy of the application, including the Enumerator's mailing address, will be available on https://nppes.cms.hhs.gov. One may also call the Enumerator, Fox Systems, for a copy. The phone number is 1-800-465-3203 or TTY 1-800-692-2326. |
| | In the fall of 2005, with the provider's permission, an organization may submit an application in an electronic file. This could mean that a professional association or perhaps a health care provider who is your employer could submit an electronic file containing your information and the information of other health care providers. |
What is the NPPES?
The National Plan and Provider Enumeration System (NPPES) was developed with the Department of Health and Human Services to process applications and assign NPIs. The NPPES will also store information about enumerated providers and apply providers' updates.
When does a provider have to apply for my NPI?
A provider may apply for an NPI through the NPPES as early as May 23, 2005. All providers must have their NPIs by May 23, 2007. Although you are not required to submit claims using an NPI until 2007, we encourage you to apply early so that you can test your systems. NPIs will be a permanent identifier, assigned for life unless circumstances justify deactivation (e.g., fraud).
. 
| |
|
|
|
Service Center
Employee Benefits
| |
|
|
|
|
Click the button below to view a list of questions/answers related to HIPAA National Provider Identifier (NPI) rules and standards.
| |
|
