The National Provider Number (NPI) is a new numeric identifier provided by the Centers for Medicare and Medicaid Services to physicians and other healthcare providers (CMS).
It’s a 10-digit number that physicians are given for their entire careers.
Who would get an NPI?
NPIs would be given to health care providers that need them to submit claims or conduct other transactions specified by HIPAA.
An individual, group, or organization that offers medical or other health services or supplies is referred to as a health care provider.
Physicians and other practitioners, physician/practitioner groups, institutions like hospitals, laboratories, and nursing homes, organizations like health care, and suppliers like pharmacies and medical supply corporations are all included.
This does not include healthcare industry employees such as admissions and billing staff, housekeeping staff, and orderlies who assist in the delivery of care but do not supply it.
How would NPIs be issued?
The National Provider System (NPS) would issue NPIs based on data entered into the NPS by one or more entities known as “enumerators.”
Enumerators would perform a variety of tasks, including entering identifying information about a health care provider into the system, data validation (for example, confirming the State license number), notifying a health care provider of its NPI, and updating information about a health care provider when the health care provider requests it.
When will the NPI be used?
Two years after the adoption of this proposed standard, the NPI must be used by health plans, health care clearinghouses, and those health care providers that conduct electronic transactions specified by HIPAA. Small health plans have three years to comply with the law.
Who Needs An NPI Number?
An NPI is necessary for any healthcare provider, clearinghouse, or institution that conducts transactions or uses health records that are subject to HIPPA laws. This covers organizations and providers who have their claims processed by a medical billing company.
HIPPA requires that any individual, business, or healthcare agency that transmits any patient health information in electronic form in connection with a transaction is required to have an NPI number.
A provider’s NPI cannot be modified once it is issued, and it remains with them regardless of their position or where they reside or work.