About HIPAA's National Provider Identifier
What is the NPI?
- The NPI is a standard, unique identifier being assigned by the Centers for Medicare and Medicaid Services to healthcare providers who transmit health information in electronic form in connection with a HIPAA standard transaction. Providers include individuals, such as physicians, dentists, pharmacists, and organizations such as hospitals, nursing homes, pharmacies and group practices.
- The intent behind the NPI is to improve the effectiveness and efficiency of electronic transmissions of health information with the utilization of one consistent provider identifier, eliminating the need for providers to use different identification numbers for different health plans.
- The NPI is a 10-digit numeric identifier consisting of 9 numbers plus one check digit in the 10th position.
- It does not contain any embedded information about the provider and never expires.
- Organizations may assign different NPIs to various departments of an organization for billing purposes.
Who is Impacted?
- Covered Entities as defined by HIPAA as healthcare providers who send claims electronically, clearinghouses and health plans, are directly impacted by the NPI.
- Healthcare providers who submit claims manually are not required, but encouraged, to obtain an NPI.
- Providers can begin applying for their NPI starting May 23, 2005.
- Effective May 23, 20071 health plans must recognize only the NPI in processing and transmitting HIPAA standard transactions. (May 23, 2008 for small health plans, those with revenues of $5 million or less).
- Providers are advised by CMS not to begin to use the NPI in HIPAA standard transactions on or before the compliance dates or until health plans have issued specific instructions on accepting the NPI.
- HIPAA standard transactions include health claims and equivalent encounter information, health plan enrollment and disenrollment, health plan eligibility, medical claim payment and remittance advices, health plan premium payments, medical claim status, referral certification and authorization, and coordination of benefits.
How do Providers Obtain an NPI?
- CMS has contracted with Fox Systems to administer the NPI application process and issue NPIs.
- CMS vendor NPI Enumerator Customer Service Center is available Monday through Friday, 9:00 a.m. to 5:00 p.m. Eastern Standard Time by calling 1-800-465-3203.
- Providers may e-mail questions pertaining to NPI application to: customerservice@NPIenumerator.com. Questions related to other aspects of the NPI legislation and regulation or other HIPAA-related matters, should be referred to the CMS HIPAA Hotline at 1-866-282-0659.
How will MultiPlan comply?
- As a Business Associate of HIPAA Covered Entities, MultiPlan is preparing to accept and utilize NPIs in connection with claims we reprice.
- A field has been added to practitioner applications to capture the NPI, with a note to contact CMS to apply for an NPI.
- We have added a field in our database to capture the NPI.
- The tax identification number (TIN) is still a required field on all claims.
- We are closely monitoring the availability of data feeds from CMS that will enable us to capture assigned NPIs in bulk and matching to existing provider identifiers.
- We will work with our clients for data feeds of NPIs as needed.
1On April 2, 2007, CMS stated that HIPAA covered entities may implement contingency plans for up to 12 months and CMS will not take enforcement actions against entities that do not meet the May 23, 2007 compliance deadline, as long as the entities have been making a good faith effort to comply with the NPI requirements.