National Provider Identifier (NPI)

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What is the National Provider Identifier (NPI)?

  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. This standard unique health identifier is the National Provider Identifier (NPI).
  • Once implemented, covered entities (including Medicare) will use only the NPI to identify health care providers in all standard transactions.
  • The Department of Health and Human Services (DDHS) Office of HIPAA Compliance (OHC) is the lead on the project management, assessment, and remediation of this new identifier.

Important Dates
  • The DHHS published the Final Rule on January 23, 2004, adopting the NPI as the Standard Unique Health Identifier of Health Care Providers. (45 CFR Part 162)
  • The effective date of the Final Rule is May 23, 2005, 16 months after Final Rule Publication.
  • The compliance date for all covered entities is May 23, 2007, except for small health plans, which have until May 23, 2008 to comply.
  • Beginning May 23, 2005, all health care providers can apply for their NPI.
  • Between May 23, 2005 and January 2, 2006, Medicare's claims processing systems will accept an existing legacy Medicare number and reject as unprocessable any claim that includes only an NPI.
  • Between January 3, 2006 and through October 1, 2006, Medicare's systems will accept an existing legacy Medicare number or an NPI, as long as an existing legacy Medicare number accompanies it.
  • Beginning October 2, 2006 and through May 22, 2007, Medicare's systems will accept an existing legacy Medicare number and/or an NPI. This allows for 6-7 months of provider testing before the Medicare program only accepts an NPI on May 23, 2007.
  • Beginning May 23, 2007, Medicare's systems will only accept an NPI.

Requirements for NPI
  • The NPI is a unique numeric 10-digit identifier, consisting of 9 numbers plus a check-digit in the 10th position. NPIs will initially be issued with the first digit = 1 or 2.
  • The NPI will not have embedded intelligence (information about the health care provider that it identifies).
  • The assigned NPI does not expire.
  • At current rate of health care provider growth, NPI numbers can continue to be assigned for 200 years.

What are the Benefits of NPI?
  • Reduce costs and improves efficiency.
  • NPI eliminates the need for health care providers to maintain and use multiple identification numbers assigned by the various health plans they bill.

Who gets an NPI?
  • All covered health care providers that need NPIs to submit claims or conduct other transactions specified by HIPAA must request an NPI.

National Plan and Provider Enumeration System (NPPES)
  • The NPPES was built under a CMS contract.
  • The NPPES will receive and process NPI applications and updates from providers.
  • The NPPES generates the NPI and notifies providers of their NPIs.
  • The NPPES ensures uniqueness of health care providers.
  • The NPPES assists covered health care providers in completing applications and furnishes updates.
  • The NPPES is responsible for resolving problems and answering questions.
  • Please note: Your tax identification number can still be requested.

How will covered health care providers get their NPI?
  • Covered health care providers will first need to determine who in their organization needs an NPI.
  • Next, covered health care providers will need to complete an application form by paper or over Internet (www.nppes.cms.hhs.gov link to website outside of wpsmedicare opens a new window).
  • The enumerator will assign an NPI to covered health care providers.

NPI Resources

Page Last Updated: Monday, 09-Jun-2008 13:34:22 CDT