National Provider Identifier (NPI)

Attention all health care providers - by May 23 2008 YOU must have an NPI, or your cash flow and business may be jeopardized:
  1. Where does it come from?
    The first indicator of the NPI was in HIPAA of 1996, which mandated the provision of a standard unique health identifier for all health care providers. In 2004, HHS published a Final Rule that formally adopted the NPI to be administered by a National Provider System.

  2. Why was it instituted?
    The NPS/NPI simplifies and reduces the present complexity of multiple provider and health plan ID numbers. It avoids multiple billing numbers and billing across contractors. One identifier lets the HCFA monitor the complete picture of a provider's billing practices, allowing the HHS-OIG to identify and track abusive providers using numerous billing numbers in the past.

  3. What is it?
    The NPI will be a 10-digit unique numeric identifier in place of other identifiers (e.g. Medicare number, UPIN) for all health care transactions between providers and payers, for which HHS has established HIPAA standards. It will replace the different provider identifiers (legacy numbers) used now for each health plan with which providers do business. The NPI does not replace the enrollment process for Medicare or tax identification numbers.

  4. Who is affected?
    All HIPAA covered healthcare providers, individuals or organizations, must obtain an NPI to identify themselves in HIPAA standard transactions. Once issued, the NPI will not change. It remains with the provider regardless of job or location changes. This does not include health industry workers, such as admissions and billing personnel, housekeeping staff, and orderlies, who support the provision of health care but do not provide actual health care services.

  5. When does it come into effect?
    By May 23 2008 providers that conduct electronic transactions with all government medical plan payers must use the NPI, whether individual doctors or hospitals. Only very small health plans have an additional year until May 23, 2008 to obtain and use their NPI.

  6. How does it work?
    HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must eventually use only the NPI to identify covered healthcare providers in standard transactions. Once a health care provider is assigned an NPI, it will no longer use its Medicaid number, UPIN, Medicare Provider number, health insurance plan number, according to the TIMELINE below.

CRITICAL TIMELINES

  • Beginning January 3, 2006, and through October 1, 2006, CMS systems will accept an existing legacy Medicare number or an NPI as long as it is accompanied by an existing legacy Medicare number.
  • Beginning October 2, 2006, and through May 22, 2007, CMS systems will accept an existing legacy Medicare number and/or a NPI.
  • Beginning May 23, 2008, CMS systems will only accept a NPI. Health plans with which providers do business may instruct them before this date as to when they may begin using the NPI only in standard transactions.

CAUTIONS

  1. Once you have your NPI, you may need to modify your existing business processes to use the NPI and to share it with health care providers with whom you do business.
  2. When applying for your NPI you should include your legacy identifiers for Medicare and all payers. For a Medicaid number, include the State name. This information is critical for payers in the development of cross-referencing to aid in the transition to the NPI.
  3. You may need to identify sub-parts if you are a health care organization.
  4. You may need to verify and update all data related to your health plans and employees.

Obtaining your NPI

The Centers for Medicare and Medicaid Services (CMS) oversees the implementation of HIPAA if us mandate for unique identifiers through the National Plan and Provider Enumeration System. The national enumerator named by CMS and currently issuing NPI is:

Fox Systems, Inc.
NPI Enumerator
PO Box 6059
Fargo, ND 58108-6059
1-800-465-3203
1-800-692-2326 (TTY)

Email:customerservice@NPIenumerator.com

Website:www.nppes.cms.hhs.gov

Fox will process applications from health care providers and operate a help desk to assist the min obtaining the new NPI. YOU can get yours quite quickly by contacting the NPI Customer Service Centre. Follow the steps below to expedite YOUR and your Organization's application process.

The NPI Enumerator Customer Service Center and Help Desk will be available:
Monday through Friday 9:00 a.m. to 5:00 p.m. EST.

Please Call the NPI Customer Service Center at: 1-800-465-3203