CMS: Mandatory NPI use

Medicare will begin rejecting claims from fee-for-service contractors without an NPI (National Provider Identifier) as early as July 1, 2007. This rule goes into effect May 23.

Earlier this year, Medicare said it was delaying mandatory use of NPI for as long as a year.

The revised directive from Medicare says providers should obtain their NPI now. They can apply on line at https://nppes.cms.hhs.gov/ on the Centers for Medicare and Medicaid Services’ (CMS) Web site. Furthermore, they should also make sure their billing staffs begin to include the NPI on claims as soon as possible.

The 1996 Health Insurance Portability and Accountability Act (HIPAA) required each physician, supplier, and other healthcare providers conducting HIPAA standard electronic transactions to be issued a unique NPI. CMS began to issue NPIs May 23, 2005, and to date has been allowing transactions adopted under HIPAA to be submitted with a variety of identifiers.

After May 23, 2008, legacy numbers will not be permitted on any inbound or outbound transactions.

The directive CR 5595, which indicates the change in date, is available on the CMS Web site at www.cms.hhs.gov/Transmittals/downloads/R1227CP.pdf.

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