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ONE YEAR REMAINS BEFORE NATIONAL PROVIDER IDENTIFIER USE IS REQUIRED IN ALL STANDARD TRANSACTIONS
ONE YEAR REMAINS BEFORE NATIONAL PROVIDER IDENTIFIER USE IS REQUIRED IN ALL STANDARD TRANSACTIONS
Covered health care providers have one year to obtain National Provider Identifiers (NPI). The NPI must be used in standard health care transactions, specified by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) no later than May 23, 2007, by covered health care providers, health plans and health clearinghouses.
Health care providers are urged to apply for the NPI well before May 22, 2007. Legacy identifiers will not be accepted after that date; however, small health plans have until May 23, 2008 to comply.
The identifier helps to ensure that medical claims are processed on time and payments are made correctly. The NPI is a10-digit, numeric identifier that does not expire or change, and is administered by the Centers for Medicare & Medicaid Services (CMS).
Once a covered health care provider has an NPI, it must share the NPI with any entity that needs it to identify the covered health care provider in a standard transaction. Health plans and health care clearinghouses should make every effort to ensure that the NPI is incorporated into their systems and processes so that they can be used successfully by the May 23, 2007 deadline.
The Medicare fee-for-service program began accepting the NPI, along with the Medicare legacy identifiers, from health care providers in HIPAA standard claims transactions in January 2006.
Health care providers may obtain their NPI in one of three ways:
- Apply on-line by using the web (https://NPPES.cms.hhs.gov);
- Call the NPI Enumerator (1-800-465-3203) and request a paper NPI application form, complete it, and mail it back to the address on the form; or
- Apply for a bulk enumeration, which allows an Electronic File Interchange Organization (EFIO) approved by CMS to obtain a number of providers’ NPI.
For more details about NPI and EFI, visit www.cms.hhs.gov/NationalProvIdentStand/.