Everything About NPI

We used to be different numbers but everything changed by one word.

National provider identifier


The National Provider Identifier (NPI) was developed out of the Administrative Simplification in the Health Care Industry provisions under HIPAA. Finalized in 2002, the NPI is intended to facilitate streamlined communications between providers and payers, as well as encourage electronic transmission of healthcare information. Specific provisions of the NPI are aimed at replacing the numerous provider IDs currently issued by carriers and creating a national, standardized identification system for providers. For more information on the National Provider Identifier, here are a few commonly asked questions, along with resources for further reading.


What is the National Provider Identifier?
A unique 10-digit identifier assigned to healthcare providers and organizations to standardize recognition of providers in electronic healthcare transactions. Providers who fall under the definition of a “covered entity” are required to obtain a NPI prior to May 23, 2007.



How do I know if I'm a covered entity or need a NPI?
Covered entities are, generally, healthcare providers and organizations (such as doctors, hospitals, clinics, labs etc.) that engage in certain electronic transactions. The Centers for Medicare and Medicaid Services (CMS) website offers a Covered Entity Decision Tool to help ascertain whether or not you or your organization is considered a covered entity under HIPAA.

What is the timeline for implementation of the NPI?
As of May 23, 2005 - healthcare providers were able to apply for a NPI.
May 23, 2007 - all covered entities are required to have an NPI to engage in electronic transactions. By this date, all major payers and insurance carriers are required to have the capability to comply with NPI usage for electronic transactions.
May 23, 2008 - smaller health insurance plans and payers are required to meet compliance for

NPI usage in electronic transactions.


So how do I apply for a NPI?
NPI applicants can:
Apply directly with CMS online at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do,
Download the application from the page above and submit via mail,
Call 1-800-465-3203 to request a copy mailed to you,
Or, with your permission, an organization can submit an electronic application on your behalf.


Other thoughts and considerations:
Using a medical billing company or other third party claims administrator does not exempt you from obtaining a NPI. Virtually all health care providers required to go through this process.
Filing for the NPI does not replace the credentialing process with Medicare or any other insurance carriers; although, your NPI will be used across all payers - eventually replacing your existing provider IDs with other carriers.

Your NPI should be kept private, similar to a social security number. It will become part of your identity as a practicing provider and shared sparingly among only those who need it to process transactions.


Where can I find additional information on NPI?
CMS provides a brief summary through the
National Provider Identifier Fact Sheet.
CMS has posted a link to the final rule on the NPI in the Federal Register (Vol. 67, No. 105/Friday, May 31, 2002/Rules and Regulations, pp. 38009-38020) at:
www.cms.hhs.gov/EmployerIdentifierStand/Downloads/empIDfinal.pdf.
CMS'
NPI Questions pages provides detailed responses to some of the most common questions.

The Workgroup for Electronic Data Interface (WEDI) has taken the lead as an industry focal point “for information related to the planning, transition and implementation of the NPI.” WEDI offers an excellent, objective resource, including whitepapers on impact as well as the latest NPI news. Visit their
National Provider Identifier Outreach Initiative page for more information.

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