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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.

Reminder: Use the NPI for All Claims and TARs Update

November 4, 2008

Effective for dates of service on or after October 1, 2008, the Department of Health Care Services (DHCS) is only accepting the National Provider Identifier (NPI) on all Medi-Cal and Child Health and Disability Prevention (CHDP) program claims.  The only exceptions to this requirement for claims are “atypical” providers such as Blood Banks, Christian Science Practitioners and Multipurpose Senior Services Program providers that will continue to use Medi-Cal legacy provider numbers. 

Medi-Cal providers currently in the process of transitioning to the NPI may still have claims processed using the legacy number, but they must register their NPI with Medi-Cal and begin using it for all transactions immediately. 

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What's New?

Previous Articles

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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