NPI

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NPI

Overview

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for health care providers, the National Provider Identifier (NPI). The NPI final rule issued January 23, 2004 adopted the NPI as this standard. The NPI is 10 digits in length and will replace health care provider identifiers in use today, including the nine-digit Medi-Cal provider number. To comply with this requirement, the Centers for Medicare & Medicaid Services (CMS) developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers.

NPPES began accepting applications and issuing NPIs, on May 23, 2005. All health care providers (e.g., physicians, suppliers, hospitals, etc.) are encouraged to obtain their NPI as quickly as possible. A hard copy application may be requested by contacting the NPPES contractor at 1-800-465-3203 (NPI toll-free). Applications can be submitted online at the NPPES Web site or by mail to:

NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059

When applying for an NPI, CMS urges providers to include their legacy identifiers for all payers (e.g., health insurance plans, State Medicaid agencies, Medicare). If reporting a Medicaid number, include the associated state name. This information is critical for payers in the development of crosswalks to aid in the transition to the NPI.

Covered health care providers must obtain an NPI by May 23, 2007. For additional questions regarding NPI, contact the Telephone Service Center (TSC) at 1-800-541-5555, select language preference (option 11 for English; option 12 for Spanish), select option 16 from the main menu, then select option 18 from the sub menu.

NPI Update: End of Dual-Use Period In October 2007, the Department of Health Care Services (DHCS) announced the extension of Medi-Cal’s “dual-use” period to continue beyond November 26, 2007. During the dual-use period, providers have been required to use both the Medi-Cal provider number and the National Provider Identifier (NPI). The only exception to the dual-use rule was for those transactions where both sets of provider identifiers are not supported. In these cases, providers were instructed to continue to use the Medi-Cal provider number. Effective December 17, 2007, providers will no longer need to use both sets of identifiers on claims, as DHCS will be able to accept either an NPI only, or a Medi-Cal provider number only. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise. Claims Submission Update Effective December 17, 2007, claims submitted using both identifiers will be processed based solely on the NPI. If the Medi-Cal provider number is included along with the NPI (dual-use), it will not be used for processing beyond December 17, 2007. As a result of using the NPI on claims, paper Remittance Advice Details (RADs), ASC X12N 835 Health Care Claim Advice/Payment and/or Supplemental Claims Processing Information (SCPI), (formerly known as Automated Remittance Data System, or ARDS), will be consolidated under the single NPI received. Note: When a claim is submitted with an NPI (including dual-use claims) the associated Medi-Cal provider number(s) will be end-dated effective for dates of service beyond the date of NPI claim submission. Using only the associated Medi-Cal provider number(s) following an NPI claim submission will result in claim denials for subsequent dates of service. Transition Results Medi-Cal providers who had obtained an NPI and began submitting it along with their Medi-Cal provider number on the ASC X12N 837 v.4010A1 claim transaction and universal claim forms allowed for Medi-Cal to compare provider claim submission data with NPI registration data. As a result, it was found that claims payment success under the NPI is likely. However, discrepancies were found between the NPI/Medi-Cal provider number combinations received and the NPI/Medi-Cal provider number combinations registered with Medi-Cal. For a complete list of discrepancies found, please refer to the NPI Registration Errors and Discrepancies document. Read More

What's New?

Previous Articles

• Register NPI Used in Medicare Crossover Claims
• Complete Implementation of National Provider Identifiers
• Revised Proprietary Forms Reminder
• NPI Enumeration Guideline
• Automatic Crossovers May Cause Overpayments to Certain Clinics
• Provider Identification Number Reissue Update
• NPI and Legacy Number Billing Guidelines for Deactivated Providers
• NPI Registration for Facilities
• Reminder: End-Dating of Medi-Cal Provider Numbers
• Important NPI Information for Providers

What's Next?

• Medi-Cal will continue to provide NPI information through Medi-Cal Updates and other educational media. More information about the NPI is available from the CMS Web site.

Related Links:
https://nppes.cms.hhs.gov – To apply for an NPI
http://www.wedi.org – Provider based NPI Workgroups and Analysis (Subparts)
http://www.cms.hhs.gov/NationalProvIdentStand – Full policy and Medicare recommendations
http://www.cms.hhs.gov/apps/npi/npiviewlet.asp – NPI Tutorial

Downloads:
Health Care Provider Taxonomy List

If you are registering your NPI for the first time, please read the Registration Instructions.

Note:

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