What is an NPI Number?
The NPI (National Provider Number) Number is a 10-digit numerical identifier that identifies a healthcare entity or individual provider. For billing purposes, an NPI number is shared with other providers, employers, health plans, and payers.
CMS.gov’s Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard, unique health identifier for each healthcare provider.
In the administrative and financial transactions required by HIPAA, all covered healthcare providers, health plans, and healthcare clearinghouses must have NPI numbers.
How do you get an NPI number?
The National Plan and Provider Enumeration System is the quickest way for health care providers and organizations to obtain an NPI number.
It should take about 20 minutes to complete the application, and an NPI number can be obtained in as little as 10 days.
Individual providers must first generate a username and password in the Identity & Access Management System (I&A) and then use those credentials to log into NPPES.
Providers can also apply for an NPI number on their own or through a third-party entity.
For accurate medical billing and faster revenue cycle management, NPI numbers are essential. Any claim submitted without a valid, registered NPI will be denied by any health plan, as it is required by HIPAA regulations to track healthcare services and reimbursement.
Who is eligible for an NPI number?
A National Provider Identifier is available to all individuals and organizations who meet the definition of a healthcare provider as defined by 45 CFR 160.103.
These include health plans, health plan clearinghouses, healthcare providers who send health information electronically, and healthcare organizations that send protected health information to covered entities who need it.
You must have an NPI if you are a HIPAA-covered provider, a healthcare provider, or a supplier who bills federally funded programs for services. Providers need an NPI Number before enrolling with Medicare.