National Provider Identification

From Conservapedia
Jump to: navigation, search

The National Provider Identifier (NPI) is a unique number assigned to health care practitioners (e.g., physicians) and health care organizations (e.g., facilities or group practices). Each health care practitioner (e.g., physician) can obtain an individual NPI number. Health care organizations can obtain multiple NPI numbers to represent different organizational parts.

Health care providers who are not covered entities under HIPAA are not required to obtain an NPI.

The Centers for Medicare and Medicaid (CMS) generates the NPI numbers, and applications are available online. CMS will require an NPI number by any practitioner, including someone not covered by HIPAA, on Medicare electronic or paper claims.

Beginning May 23, 2007, all HIPAA electronic standard transactions must use an NPI number. Paper claims are being modified to include an NPI.

In April 2007, CMS announced a 12-month extension in the deadline with respect to enforcement of the NPI for covered entities that are making a "good faith" effort to comply.

Uses of the NPI

HHS announced that an NPI may be used for the following purposes:[1]

  • The NPI may be used as a cross-reference in health care provider fraud and abuse files and other program integrity files.
  • The NPI may be used to identify health care providers for debt collection under the provisions of the Debt Collection Improvement Act of 1996 (Pub. L. 104–134, enacted on April 26, 1996) and the Balanced Budget Act of 1997 (Pub. L. 105–33, enacted on August 5, 1997).
  • Health care providers may use their own NPIs to identify themselves in nonstandard health care transactions and on related correspondence.
  • Health care providers may use other health care providers NPIs to identify those other health care providers in health care transactions and on related correspondence.
  • Health plans may use NPIs in their internal health care provider files to process transactions and in communications with health care providers.
  • Health plans may communicate NPIs to other health plans for coordination of benefits.
  • Health care clearinghouses may use NPIs in their internal files to create and process standard transactions and in communications with health care providers and health plans.
  • NPIs may be used to identify health care providers in patient medical records.
  • NPIs may be used to identify health care providers that are health care card issuers on health care identification cards. We encourage health care providers that are not required to comply with HIPAA regulations to use NPIs in the ways listed above.

References

  1. http://209.85.165.104/search?q=cache:N42ReQj9VwIJ:www.hipaadvisory.com/REGS/finalprovid/uses.htm+NPI+providers+%22not+required%22&hl=en&ct=clnk&cd=4&gl=us