AAOS Bulletin - August, 2006

Do you have your NPI?

Are you drowning in a sea of provider numbers? Do you have to keep track of many different identifiers, provider numbers and provider identification numbers? Do you forget which number to use with which payer? If so, you obviously haven’t yet applied for your National Provider Identifier (NPI).

The NPI eliminates the need for multiple identifiers for different entities. Like your Social Security number, your NPI is with you for life, regardless of job or location changes.

All health care providers—whether organizations or individuals—covered by the Health Insurance Portability and Accountability Act (HIPAA) must obtain an NPI and use it on all HIPAA standard transactions beginning May 23, 2007.

What is it?

The NPI is a 10-digit numeric identifier that contains no embedded information about the health care provider, such as the state in which he or she practices, provider type or specialty.

The NPI was mandated under HIPAA. It’s a standard, unique identifier for health care providers, developed by the U.S. Department of Health and Human Services. With an NPI, there’s no need for health care providers to keep track of multiple numbers to identify themselves in standard transactions with multiple health plans.

The NPI will enable a simpler electronic transmission of HIPAA standard transactions and more efficient coordination of benefits transactions, but it will not change or replace the current Medicare enrollment or certification process.

By May 23, 2007, every provider completing electronic transactions must use only the NPI. This means you must apply for and receive your NPI before that date. The Centers for Medicare and Medicaid Services (CMS) recommends that you obtain your NPI at least six months prior to this date to provide you with ample time to test your NPI and share it with all of your health care partners, including payers, clearinghouses, vendors and other providers.

To obtain an NPI, visit the National Plan and Provider Enumeration System Web site. You can apply online, or print out an application form to complete and forward to the company that is responsible for assigning numbers. In some cases, an organization (such as a hospital) may submit a request for an NPI on behalf of a provider, with provider permission. For more information on the NPI, visit online.

Tips from CMS

The CMS offers the following tips on your national provider identifier:

• When applying for your NPI, include all legacy identifiers, not only for Medicare but for all payers. If you are reporting a Medicaid number, include the associated state name.

• Take control of your NPI. If you are a billing provider, your NPI will be your billing number. Your NPI belongs to you, even if your employer or a health plan obtained it for you by bulk enumeration. It is the one number that identifies you as a health care provider in standard transactions with other health care providers, health plans and health care clearinghouses.

• Use your NPI. After May 23, 2007, the NPI will be the only health care provider identifier that you or health plans will use to identify you as a health care provider in standard transactions, such as claims and encounter information transactions, coordination of benefits transactions, claims status inquiries/responses, eligibility inquiries/responses, payment and remittance advices, enrollment/disenrollment in health plans and referrals. Your NPI will be used by all health plans, including Medicare, Medicaid, and all other private and public payers, to identify you as a health care provider.

• Protect your NPI. You are eligible for only one NPI regardless of the number of different places you furnish health care or the number of different contracts you may have with health plans and other health care providers. Only in rare and unique circumstances, such as fraudulent use of your NPI by another, will you be able to contact the NPI Enumerator to obtain a new NPI to replace the one that was initially assigned to you.

• Remember to update your NPI when necessary. If you are a covered health care provider, you must report any changes to any of the information that was furnished to obtain your NPI within 30 days of the change.

• Share your NPI as needed. Certain covered entities and others (your employer, hospitals where you have privileges and health care providers to whom you refer patients) will need to know your NPI to conduct standard transactions. Health plans in which you are enrolled and to whom you submit claims also need to know your NPI to ensure you receive proper payment for services rendered.

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