May 2005

National provider identifier program launched

The Centers for Medicare and Medicaid Services (CMS) has announced the availability of a new healthcare identifier for use in HIPAA standard transactions. The National Provider Identifier (NPI) will be a single provider identifier that replaces the various provider identifiers you use with each health plan with which you do business.

Adoption of the NPI is part of the implementation of HIPAA rules. With the use of NPIs, healthcare providers will be able to submit standard transactions electronically to any health plan in the United States. Transactions include claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance advices.

The NPI will replace the healthcare provider identifiers used today in standard transactions. Many health plans, including Medicare, Medicaid, and private health insurance issuers, and all healthcare clearinghouses must accept and use NPIs in standard transactions by May 23, 2007. Small health plans have until May 23, 2008.

Although you can apply for NPI beginning May 23, 2005, Medicare is not yet accepting the NPI in standard transactions. The agency will issue instructions on time frames and implementation of NPI for Medicare billing in 2006.

In a letter to healthcare providers, CMS states, “You may receive notices about the NPI from many of the health plans with which you do business. Remember that you need apply once for an NPI. The same NPI is used for every health plan.

Providers can apply for the NPI in one of three ways:

For more information on NPI, go to https://nppes.cms.hhs.gov.

Source: Centers for Medicare and Medicaid Services, www.cms.gov