Medical billing concept - All about NPI

Everything you should know about National Provider Identifier (NPI)?



Today everything and everywherr is NPI.The NPI is a 10-position numeric identifier (10-digit number). The number is "intelligence-free, meaning it does 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), such current Iowa Medicaid numbers;
· Unique Physician Identification Numbers (UPINs) used by Medicare.


They do not include taxpayer identifier numbers (TINs) such as:

· Employer Identification Numbers (EINs); or
· Social Security Numbers (SSNs).


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.


Why do I need my National Provider Identifier (NPI) now, when I've been told it's not required until 2007?


While it is true that providers and suppliers will need to use their NPI in all transactions beginning May 23, 2007, timely reporting of the NPI to the IME and other payers will enable them to link a provider's existing billing numbers to the new NPIs, which should in turn, help assure timely claims payment at the deadline.

Will the ten-digit NPI number replace the current seven-digit MediPASS authorization number on claims requiring a MediPASS referral after NPI is implemented?

Yes. Based upon the Federal HIPAA requirements, Iowa Medicaid will require use of the NPI number for all electronic and paper claims beginning May 23, 2007. This will include the MediPASS authorization (in cases where it is required). This authorization will still be located in box 17 of the CMS 1500 claim form.


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