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| What is the National Provider Identifier (NPI)? | |
| The NPI is a 10-position, intelligence-free
numeric identifier (10-digit number). This means that the numbers do not
carry other information about healthcare providers, such as the state in
which they live or their medical specialty. Beginning May 23, 2007 (May
23, 2008, for small health plans), the NPI must be used in lieu of legacy
provider identifiers. Legacy provider identifiers include: • Online Survey Certification and Reporting (OSCAR) system numbers; • National Supplier Clearinghouse (NSC) numbers; • Provider Identification Numbers (PINs); and • Unique Physician Identification Numbers (UPINs) used by Medicare. They do not include taxpayer identifier numbers (TINs) such as: |
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| Is a health care provider required to obtain an NPI? | |
| Yes. Under the NPI Final Rule (69 FR 3434), a health care provider who is a covered entity under HIPAA is required to obtain an NPI and to use it to identify itself as a health care provider in HIPAA transactions no later than May 23, 2007. Small health plans must use the NPI no later than May 23, 2008. A health care provider is a covered entity if it transmits any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard. For example, any health care provider (individual or organization) who sends electronic health care claims to a health plan(s),is a covered provider and must obtain an NPI. Health care providers who are not covered providers may elect to apply for NPIs, but are not required to do so. | |
| What is the purpose of the NPI? Who must use it, and when? | |
| The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions by the compliance dates. The compliance date for all covered entities except small health plans is May 23, 2007; the compliance date for small health plans is May 23, 2008. As of the compliance dates, the NPI will be the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities | |
| How do I obtain an NPI? | |
| Register for an NPI number here -> https://nppes.cms.hhs.gov/NPPES/Welcome.do | |
| On what date do health care providers need to use their National Provider Identifier (NPI)? | |
| Covered entities as defined by the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) who conduct
HIPAA standard transactions must use only the NPI to identify covered health
care providers in standard transactions on and after May 23, 2007. Small
health plans must use only the NPI by May 23, 2008. |
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| Should all institutional providers submit a taxonomy code on their claims after the implementation of the National Provider Identifier? | |
| Only institutional providers that currently bill Medicare using more than one legacy identifier in order to identify sub-parts of their facility are required to submit a taxonomy code on all of the claims they submit to Medicare. Medicare legacy identifiers are six digit Medicare provider numbers, also called OSCAR numbers. A table of legacy identifiers that were used to identify sub-parts is included as an attachment to CMS Change Request 5243. Taxonomy codes shall be reported by these facilities whether or not the facility has applied for individual NPIs for each of their subparts. Institutional providers that do not currently bill Medicare for sub-parts are not required to use taxonomy codes on their claims to Medicare. | |
| If a health care provider with an NPI moves to a new location, must the health care provider notify the enumerator of its new address? | |
| A covered health care provider must notify
the enumerator of changes in any of the information that it furnished on
its application for a National Provider Identifier (NPI), and must do so
within 30 days of the change. We encourage health care providers who have
been assigned NPIs, but who are not covered entities, to do the same. |
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| Will health plans link the National Provider Identifiers (NPIs) of group practices to the NPIs of the health care providers who are members of the group practices? | |
| Health plans have business needs for the capability to create these linkages. Traditionally, health plans have maintained linkages between group practices and the members of the group practices in order to properly process and pay claims. As part of their implementation of the NPI, health plans have a need to map their legacy identifiers to health care providers’ NPIs, including the legacy identifiers and NPIs of group practices and their members. | |
| I belong to a group practice and our claims contain the group practice identification number. How can my individual analysis be done if my identification number is not on the claim? | |
| The performing professional’s NPI
must be indicated for the quality-data codes and related services. For claims
submitted via the ASC X12N 837 professional health care claim transaction,
the group practice NPI is placed in the provider billing segment, loop 2010AA,
and the performing professional’s NPI is placed in loop 2420A. For
claims submitted via the CMS 1500 form, the performing professional’s
NPI is placed on the individual line item. Placing the performing eligible
professional’s NPI on the individual line item will allow the analysis
of successful reporting and the bonus payment calculation to be performed
at the individual level, though payment will be made at the TIN level. |
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| I applied for my National Provider Identifier (NPI) over the web and haven’t received the NPI Notification. What should I do? | |
| The Contact Person should first check the computer’s SPAM filter to ensure that the NPI Notification e-mail has not been routed to SPAM. If the NPI Notification is not in the SPAM filter and it has been 15 days since the NPI application was submitted over the web, the health care provider or the Contact Person should contact the NPI Enumerator at 1-800-465-3203. | |
| Will a health care provider continue to use other numbers besides the NPI to identify itself in standard transactions after the compliance date? | |
| Upon the compliance dates, only the National Provider Identifier (NPI) may be used for identification purposes for a health care provider in standard transactions; legacy identifiers (such as the Unique Physician Identification Number (UPIN), Medicaid Provider Number, Medicare Provider Number, and others) may not be used. Where a health care provider must be identified in standard transactions for tax purposes, it would use its Taxpayer Identifying Number as required by the implementation specifications. Health care provider identification numbers other than the NPI may continue to be used in the internal processes and files of health plans or health care clearinghouses if they wish to continue to use those identification numbers in those internal processes and files. | |
| What is the format of the National Provider Identifier (NPI)? | |
| The National Provider Identifier (NPI) is all numeric and is 10 positions in length: the first 9 positions are the identifier and the last position is a check digit. The check digit helps detect invalid NPIs. There is no embedded intelligence in the NPI with respect to the health care provider that it identifies. | |
| Will a health care provider’s National Provider Identifier (NPI) ever change? | |
| The National Provider Identifier (NPI) is meant to be a lasting identifier, and is expected to remain unchanged even if a health care provider changes his or her name, address, provider taxonomy, or other information that was furnished as part of the original NPI application process. There are some situations, however, in which an NPI may change such as when health care provider organizations determine they may need a new NPI due to, for example, certain changes of ownership, the conditions of a purchase, or a new owner’s subpart strategies. There also may be situations where a new NPI is necessary because the current NPI was used for fraudulent purposes. | |
| For more FAQ about the NPI Number visit : CMS NPI Frequently Asked Questions | |
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