Confusion Surrounding New National Provider Identifier
Health care providers will one day be able to use one identification number to fill out all claims forms.
Starting last May, providers have been able to submit an application to the Centers for Medicare & Medicaid Services to receive their own National Provider Identifier (NPI). This 10-digit ID number will eventually replace all other identifiers that providers use in reimbursement and other transactions with private payers, clearinghouses and government programs (including the Unique Physician Identification Number (UPIN)).
The NPI is the next phase in the federal government's effort to move the medical community toward national standards for electronic transactions as part of the Health Insurance Portability and Accountability Act (HIPAA). In theory, national standards will simplify the submission of claims and make electronic data interchange a preferable alternative to paper processing for health care providers.
The 10-digit NPI contains no embedded intelligence; that is, it contains no information about the health care provider such as the type of health care provider or State where the health care provider is located. CMS has established the National Plan and Provider Enumeration System to assign NPI numbers.
The transition from existing health care provider identifiers to NPIs in standard transactions will occur over the next 2 years. The NPI must be used by all HIPAA covered entities (other than small health plans) for standard transactions no later than May 23, 2007. These transactions include claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance advices.
The process of switching from the current system of multiple identifiers to the NPI will not be simple or cheap for health plans. Physicians can start using their NPI as soon as they receive it. However, they will likely need to use the NPI in addition to whatever identifiers they are already using for each individual payer until 2007. Providers who do not have an NPI at the end of the two year period could face delayed or rejected claims.
Health plans will notify providers when the provider can begin using the NPI in standard transactions. Providers should not begin using the NIP in standard transactions on or before the May 23, 2007 compliance date until health plans have issued specific instructions on accepting the NPI.
CMS has contracted with Fox Systems, Inc. to serve as the NPI "enumerator" and assign NPI numbers.
The best way to apply for an NPI is on-line through an easy web-based application process at https://nppes.cms.hhs.gov.
CMS estimates that it will take approximately 20 minutes to fill out an NPI application.
You can also mail in the application or authorize an organization (such as a trade association) to submit the application on your behalf.
Before filling out the on-line application make sure that you have all of the information needed to fill out the form. You will not be able to save your work if you quit before you have completed the application form. See the reverse side of this newsletter for a list of the Information Required for Individual Providers and Information Required for Organizations.
If you have questions as you fill out the form, on-line help is available from each page of the application form. In addition, Frequently Asked Questions and other information about the NPI are available at www.cms.hhs.gov/hipaa/hipaa2.
Information Required for Individual Providers to Fill Out the NPI Application
Provider Name
Provider Date of Birth
Country of Birth
State of Birth (if Country of Birth is U.S.)
Provider Gender
Mailing Address
Practice Location Address and Phone Number
Taxonomy (Provider Type)
State License Information*
*(required for certain taxonomies only)
Contact Person Name
Contact Person Phone Number and Email
Information Required for Organizations to Fill Out the NPI Application
Organization Name
Employer Identification Number (EIN)
Name of Authorized Official for the Organization
Phone Number of Authorized Official for the Organization
Organization Mailing Address
Practice Location Address and Phone Number
Taxonomy (Provider Type)
State License Information*
*(required for certain taxonomies only)
Contact Person Name
Contact Person Phone Number and Email
NPI Enumerator Contact Information
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