HIPAA: HIPAA National Provider Identifier Update
This article is the second in a series about the National Provider Identifier (NPI) and how it will affect Medi-Cal providers. It provides information about how to obtain an NPI. Providers may now begin requesting NPIs through the registration options explained in this article.
How Does a Provider Get an NPI?
Covered health care providers can obtain an NPI through one of three
registration options. Registration is the process of requesting and
receiving an NPI. The three registration options are: 1) paper
application, 2) Web application and 3) electronic file interchange
(EFI).
- Paper application – The paper application is available
at the National Plan and Provider Enumeration System (NPPES) Web
site and through the mail from the NPI Enumerator. The
Enumerator is a contractor hired by the Centers for Medicare &
Medicaid Services (CMS) to facilitate the assignment of NPIs to
health care providers. The application should be completed,
signed and mailed back to the Enumerator (retain a copy for your
records). The key application data elements are as follows:
- Provider name
- Other name used (if applicable)
- Practice location, address and phone number
- Mailing address and phone number
- Social Security Number (or alternative proof of identity for individuals)
- Employer Identification Number (for organizations)
- Date, state, country of birth and gender (for individuals)
- Taxonomy
- License number and state
- Other provider identifiers used
- Authorized official (for organizations)
- Contact information
Note: The NPPES Web site address is https://nppes.cms.hhs.gov. You may also call the Enumerator at 1-800-465-3203 or TTY 1-800-692-2326.CMS estimates that the processing time for paper applications will be approximately 20 calendar days. Click here for a sample of the form.
The official forms are now available. CMS plans to start accepting and processing paper applications July 2005.
- Web application – Health care providers can register
for an NPI through direct data entry in the
NPPES Web site. To enter data, the provider must obtain a
user ID and password from the NPPES. The Web application has
similar data element requirements to the paper application. The
resulting NPIs from Web applications will be e-mailed to the
designated contact person within five calendar days. The NPPES
Web site is now available for direct data entry registration of
an NPI.
- EFI bulk enumeration – The NPPES allows providers to
submit multiple applications in one batch file instead of single
paper or Web applications. Acceptable EFI formats have not been
established, but are expected to have similar data element
requirements to other application methods. The EFI filing
organization must obtain authorization from each provider and
must certify the accuracy of the data. After the NPIs are
issued, the EFI filing organization will be responsible for
distributing the NPIs to providers. Specific rules for EFI bulk
enumeration will be provided by CMS later in 2005.
The NPI rule designates two categories of health care providers for the enumerating process:
- Entity Type Code 1 – Will be issued to health care providers who are individual human beings (for example, physicians, nurses, dentists, chiropractors, pharmacists and physical therapists). Entity Type Code 1 NPIs are considered a permanent designation unless circumstances justify deactivation.
- Entity Type Code 2 – Will be issued to organizations (for example, hospitals, home health agencies, clinics, nursing homes, residential treatment centers, laboratories, ambulance companies, group practices, HMOs, Durable Medical Equipment suppliers and pharmacies). Entity Type Code 2 NPIs are considered a permanent designation unless circumstances justify deactivation. A new NPI is generally not required for a change of ownership, legal formation, location, address, taxonomy, name, employer identification number, state of licensure or state license number. These types of changes are submitted to the NPPES and the information is updated for the assigned NPI.
Important NPI Reminders
- As of the NPI compliance date (May 23, 2007 for providers, clearinghouses and large health plans), the NPI is the only provider identifier that will be allowed within HIPAA transactions.
- The NPPES is the CMS-sponsored system that will serve as the data repository for NPI-related information. The NPPES will be used to process new applications, updates and generate NPIs.
- The NPI Enumerator is a CMS contracted vendor that will perform provider registration and enumeration processing using the NPPES. The Enumerator enters data from paper applications, resolves problems and answers questions related to the NPI and the registration process. Once the data processing is completed, the Enumerator will notify providers of their assigned NPI.
- Providers must continue using their existing provider numbers for all Medi-Cal transactions until notified otherwise.
What’s Next?
- Medi-Cal will continue to provide NPI information through Medi-Cal Updates and other educational mediums.
- More information about the NPI is available from the CMS Web site.
Note:
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