ABOUT NPI
FAQ's - PROVIDERS
1. What is a National Provider ID (NPI) number?
2. What is the purpose for the NPI?
3. Who is required to obtain an NPI?
4. What is the deadline to obtain an NPI?
5. Can a provider’s NPI change?
6. Where can I find regulatory information about NPI?
7. How do I apply for an NPI number?
8. Is there a charge for obtaining an NPI number?
9. Can someone else obtain an NPI number for me?
10. Does my organization need multiple NPI numbers if it operates from multiple locations or branch offices?
11. Do I need to obtain an NPI number if the organization I work for already has an NPI number?
12. If I am a sole proprietor, would I be considered an individual or an organization when applying for an NPI number?
13. If I am not subject to HIPAA, do I need an NPI number?
14. Who cannot receive an NPI number?
15. Will the NPI number replace all of the various provider identification numbers I use today?
16. Will I be required to submit any other identification number with my NPI to payers, vendors or other entities?
17. If I have an NPI, am I considered an authorized or participating provider by a health plan?
18. Is NPI considered a credentialing program?
19. Does obtaining an NPI number bring me into HIPAA compliance?
NPI UPDATES
- Special NPI Task Force White Paper
(National Dental EDI Council
)
- Modification of National Provider Identifier (NPI) Editing Requirements in CR4023 and an Attachment to CR4320
(CMS - Centers for Medicare and Medicade Services)
1. What is a National Provider ID (NPI) number?
A 10-digit, intelligence free numeric identifier. NPI will replace health care provider identifiers in use today in HIPAA standard transactions.
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2. What is the purpose for the 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. On January 23, 2004, the Secretary published a Final Rule that adopted the National Provider Identifier (NPI) as this identifier.
Implementation of NPI will encourage electronic commerce in the health care industry, simplify the processes involved thereby reducing the administrative burdens on health care providers. Implementing national standards will make electronic data interchange (EDI) a viable and preferable alternative to paper processing for health care providers and health plans.
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3. Who is required to obtain an NPI?
Under the requirements of Health Insurance Portability and Accountability Act of 1996 (HIPAA), this identifier must be used by most HIPAA covered entities, which are health plans, health care clearinghouses, and health car providers that conduct electronic transactions for which the Secretary has adopted a standard (i.e., standard transactions)
b. Every health care provider who transmits electronically or who has transmitted electronically on the provider’s behalf, transactions regulated by the HIPAA Electronic Transactions and Code Set Rule (the “Transactions Rule”) must obtain an NPI.
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4. What is the deadline to obtain an NPI?
Providers already conducting ‘standard transactions’ must obtain their NPIs no later than May 23, 2007. Providers that begin conducting standard transactions after May 23, 2007 will need to obtain NPIs so they can transmit compliant transactions.
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5. Can a provider’s NPI change?
No, a provider’s NPI will be assigned once and will not change regardless of job or location changes.
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6. Where can I find regulatory information about NPI?
Link directly to CMS for more information www.cms.hhs.gov/NationalProvIDentStand/
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7. How do I apply for an NPI number?
Web-based application process – available May 23, 2005. Web link https://nppes.cms.hhs.gov
Submit a paper application to the Enumerator (entity responsible for assigning the NPI on behalf of the Secretary) – available July 1, 2005. A copy of the application is available on https://nppes.cms.hhs.gov. Or call the Enumerator for a copy at 1-800-465-3203 or TTY 1-800-692-2326.
Electronic submission – A professional association or health care provider who is your employer could submit an electronic file containing your information and the information of other health care providers. – Available Fall 2005.
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8. Is there a charge for obtaining an NPI number?
There is no fee associated with applying for or receiving an NPI number through the web-based application process or using a paper application to the Enumerator.
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9. Can someone else obtain an NPI number for me?
If you are a single provider or a part of a larger group of providers, Bulk Enumeration may be available as soon as spring of 2006. Bulk Enumeration provides administrative and financial advantages for both the provider community and the HHS, thus allowing for a representative organization (Electronic File Interchange Organization or “EFIO”) to apply for NPI on your behalf.
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10. Does my organization need multiple NPI numbers if it operates from multiple locations or branch offices?
Each organization must obtain an NPI for the entire organization or for its subparts that would be a covered health care provider as a separate legal entity. The decision on how many NPI is needed for an organization should be carefully evaluated by the organization before filing an application.
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11. Do I need to obtain an NPI number if the organization I work for already has an NPI number?
As an individual covered health care provider, who conducts standard transactions on his own behalf, must obtain an NPI, even if you work at different locations in which the facility or location has an organizational NPI.
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12. If I am a sole proprietor, would I be considered an individual or an organization when applying for an NPI number?
As a sole proprietor/sole proprietorship, you would be considered an individual entity and eligible for a single NPI using your own social security number, not EIN.
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13. If I am not subject to HIPAA, do I need an NPI number?
Although you are not regulated to obtain an NPI, you may find that health plans you are contracted may require it. Obtaining an NPI does not subject you to HIPAA guidelines.
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14. Who cannot receive an NPI number?
Any organization or entity who does not meet the definition of a ‘health care provider’. This includes billing services, networks, re-pricers, clearinghouses, transportation services, software vendors, etc.
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15. Will the NPI number replace all of the various provider identification numbers I use today?
Yes. The goal of NPI is to enumerate every healthcare provider so that they can be uniquely identified by a single number. This will replace all ‘payer’ or other assigned or commonly used provider identifiers, greatly reducing the administrative burden on healthcare providers.
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16. Will I be required to submit any other identification number with my NPI to payers, vendors or other entities?
No. Payers, such as Medicare, may request or require providers to submit both their Medicare provider identifier and their NPI for a period of time
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17. If I have an NPI, am I considered an authorized or participating provider by a health plan?
No. Your application is filed for the unique and singular purpose of obtaining a unique identifier and does not enroll you or authorize you for any health plan or group provider discount programs.
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18. Is NPI considered a credentialing program?
No. Obtaining an NPI does not provide any authorization or credentialing for any healthcare provider.
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19. Does obtaining an NPI number bring me into HIPAA compliance?
No. Obtaining an NPI will not change your compliance with HIPAA.
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