National Provider Identifier

Background: The NPI will replace the provider identification numbers that providers use today in the HIPAA standard transactions that they conduct with health plans. Those transactions include the electronic claim, eligibility inquiry and response, claim status inquiry and response, payment and remittance advice, prior authorization/referral, and coordination of benefits transactions.

Providers who conduct any of those electronic transactions must have their NPIs and be ready to use them to identify themselves, and possibly other providers, in those transactions before May 23, 2007. That is only a year from now. Some health plans might be ready to accept NPIs much earlier than next May. The health plans with whom you do business will inform you as to when you may begin using your NPIs in these electronic transactions.

• CMS reminds health care providers that they need to obtain their National Provider Identifiers (NPIs).
  
• Today, approximately 530,000 providers who are Individuals and Organizations have obtained their NPIs.
  
• Providers can obtain NPIs by:
  

· Going to the web at https://nppes.cms.hhs.gov and filling out their application on line.

· Obtaining a paper application form, filling it out, and mailing it to the NPI Enumerator. They can obtain the paper application form (CMS-10114) by downloading it from www.cms.hhs.gov/forms or by calling the NPI Enumerator at 1-800-465-3203 and requesting a copy.

· Submitting an application through Electronic File Interchange (EFI). EFI allows an approved organization, after obtaining the permission of a provider, to send the provider’s NPI application data to us in an electronic file.

• Medicare organization providers are required by the NPI Final Rule to determine if they have subparts and if those subparts should have their own NPIs. Many enrolled Medicare providers are actually subparts of other enrolled Medicare providers who are their “parents.” In January 2006, Medicare posted a paper about the subpart concept and its effect on Medicare organization providers (downloadable from www.cms.hhs.gov/NationalProvIdentStand, click on “Medicare NPI Implementation” on the left). Medicare encourages its enrolled organization providers to become familiar with the contents of that paper if they have not already done so, and to use that paper in making decisions concerning subparts and their assignment of NPIs.

• Providers and suppliers are required to include their NPI on the 04/2006 version of the

CMS-855 Medicare enrollment application when they apply to enroll in Medicare.

• Medicare will accept either the Medicare provider number (the legacy provider number) or the NPI and the Medicare provider number (both numbers) on the claims it receives from providers through October 2, 2006.
  
• Beginning October 2, 2006 and continuing through May 22, 2007, Medicare will accept the NPI or the Medicare provider number (legacy provider number) on the claims it receives from providers. If there is any issue with the provider’s NPI and no Medicare provider number is included on the claim, the provider might not be paid. Therefore, Medicare strongly recommends that providers, clearinghouses, and billing services continue to submit the Medicare provider number (the legacy provider number) as a secondary identifier until May 22, 2007.
  
• CMS has posted many documents related to the NPI, including Medicare’s timetable for implementation of the NPI, on its NPI web page: www.cms.hhs.gov/NationalProvIdentStand. We urge you to visit that website and become familiar with the NPI and how it will be used, if you have not already done so.
  
• We encourage all organizations and associations to inform their members about the need to obtain, test, and use the NPI.