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National Provider Identifier (NPI) Frequently Asked Questions

 

What is the NPI?

Part of the Health Insurance Portability and Accountability Act (HIPAA), the National Provider Identifier (NPI) regulation establishes one unique identifier for each healthcare provider or system Issued on January 23, 2004, the NPI regulation seeks to eliminate multiple identifiers currently in use.

What are the advantages of using the NPI?

Using the NPI should result in several advantages, including:

How is my NPI determined?

The NPI is a ten-digit number (nine digits plus a check digit to detect keying errors.) It is simply a random number that never expires. It contains no information about the provider, such as state of residence or license number. The National Plan and Provider Enumeration System (NPPES) issue NPIs. The federal government is also responsible for assisting providers in completing the application and resolving problems associated with an NPI.

Does the number itself have any meaning?

No. The number itself does not have any meaning - it cannot be broken into individual meaningful components.

Who is required to apply for an NPI?

All healthcare providers, defined under the regulation to include dental providers who access claims information or benefits via the Internet are also covered entities. Clearinghouses are also required to be able to accept and transmit the NPI by the federal compliance deadline.

The broad definition of healthcare "provider" provided in the regulation encompasses all who provide healthcare services: individuals (including dental hygienists, physicians and all other practitioners) as well as organizations (such as hospitals, pharmacies, clinics and medical supply companies).

What if I only submit paper claims?

If you do not submit electronic transactions governed by HIPAA, which includes claims or benefits inquiries via the Internet, you are not required to obtain an NPI. Moda Health strongly encourages you to obtain and use an NPI to submit all of your claims once we are prepared to accept it. This will enable you to maintain only one unique identifier for use with all payers. Some payers may make a business decision to require use of the NPI so it will be good to be prepared.

What about all of these other numbers I have been using?

The intent of the NPI is to replace other identifiers such as the OMAP Identifier, BC/BS Provider numbers, Medicare and Medicaid identifiers and others. In May, 2007, the NPI is the only identifier other than your TIN that you will be allowed to send in on a claim.

Is there any identifier that the NPI does not replace?

Yes. Your Tax ID number (TIN). That continues to be necessary for your payments and 1099's. Your NPI will not become your TIN.

Are there other 'national identifiers'?

Three identifiers have been planned:

Can Moda Health get numbers for the healthcare provider - or does the healthcare provider have to do this?

At this time the healthcare provider must apply for the number. The government is researching a method that might allow another organization to do this work on behalf of the provider. That work is not completed.

What is a "Provider Taxonomy Code"?

When you apply for your NPI either you will be asked to provide "your 10-digit taxonomy code." These codes are not "assigned" to healthcare providers; rather, healthcare providers select the taxonomy code(s) that most closely represents their education, license, or certification. For medical providers, it is essentially an identifier that corresponds most closely to the area of specialty. To facilitate your registration, the taxonomy codes applicable to all healthcare providers are available at www.wpc-edi.com.

When is the deadline for application?

All HIPAA "Covered Entities" must use NPIs on all HIPAA-governed transactions by the compliance date of May 23, 2007. To assure a smooth transition, all providers are urged to apply for their NPI well in advance of the compliance date.

How will the NPI affect other numbers I've used in the past?

The NPI will replace other identifying numbers currently used in electronic transactions, such as the Medicaid, Blue Cross and Blue Shield, UPIN, CHAMPUS, and certain other "legacy" numbers. The NPI will not replace the Social Security number, DEA number, Taxpayer ID number, taxonomy number, or state license number, since these are used for purposes other than general identification . Taxpayer ID numbers or Social Security Numbers must still be provided for 1099 purposes, but the NPI will replace all other identifiers on the claim. During the two-year implementation period, however, you may be asked to submit your NPI as well as other legacy identifiers to payers and clearinghouses. As of May 23, 2007, however, payers will not be allowed to require additional identifiers beyond the NPI.

Who else can I talk to?

What other resources can you direct me to?

The ADA at www.ada.org

The Federal Government at www.cms.hhs.gov which includes all HIPAA information, or specifically at www.cms.hhs.gov/NationalProvIdentStand/

Workgroup for Electronic Interchange (WEDi) www.wedi.org/

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