Doctors Q & A
Everything You Need to Know about the New, Mandatory National Provider Identifier (NPI)
Q. I keep hearing about "NPI." What is it and do I really need to obtain one?
A. Section 1173(b) of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") requires the Secretary of Health and Human Services to develop a system whereby each health care provider and practice could be identified by a unique health identifier. This requirement is based upon the belief that such a national identifier will improve the efficiency and security of claims submission and data exchange. In response to this congressional mandate, the Secretary created the National Provider Identifier, which is also known as the "NPI."
The NPI is a string of ten numbers that uniquely identifies a health care provider. You will soon be required to use your NPI as the exclusive identifier for all 'standard transactions' including eligibility inquiries and electronic and HCFA claim submissions to commercial and governmental payers. As such, your NPI will be used in many situations in which another legacy provider identifier, contract number or the like is presently utilized.
When will I be required to use an NPI?
For the time being, you are free to continue utilizing a non-NPI identifier as a primary identifier for any standard transactions. Nevertheless, it is in your best interests to obtain an NPI immediately since payers are increasingly requesting that you use it. Further, as of May 23, 2007, you must have an NPI in order to submit claims to, or receive payments from, most payers.
How can I obtain an NPI?
If you would like to obtain an NPI, you can do so in one of two ways. First, you can apply for an NPI online through the National Plan and Provider Enumeration System at https://nppes.cms.hhs.gov. Alternatively, you can obtain a paper application by calling 1-800-465-3203 or by visiting the CMS website at www.cms.hhs.gov and selecting the appropriate form.
If you apply online for an NPI, you can expect to receive an identifier in less than two weeks. If you submit your application on paper, you should expect a wait of two weeks or more. Either way, if you get the process started soon, you will remain ahead of the curve.
What if I still have questions regarding the NPI?
If you still have any questions regarding the NPI, please do not hesitate to contact me via email at ssnyder@mtbc.com or by telephone at 732-873-5133 x.113.
Stephen A. Snyder, Esq.
Vice President/General Counsel
Disclaimer: The information contained within the MTBC® Legal Corner is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Legal Corner does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances