The National Provider Identifier (NPI) The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for health care providers.  The NPI Final Rule issued January 23, 2004 adopted the NPI as this standard. What is a National Provider Identifier? The NPI is a 10-digit, intelligence free numeric identifier (10 digit number).  Intelligence free means that the numbers do not carry information about health care providers, such as the state in which they practice or their provider type or specialization. The NPI will replace health care provider identifiers in use today in HIPAA standard transactions.  Those numbers include Medicare legacy IDs (UPIN, OSCAR, PIN, and National Supplier Clearinghouse or NSC). The provider’s NPI will not change and will remain with the provider regardless of job or location changes. Having an NPI does not: Ensure a provider is licensed or credentialed. Guarantee payment by a health plan. Enroll a provider in a health plan. Turn a provider into a covered provider Require a provider to conduct HIPAA transactions. Why do we need the National Provider Identifier? Simpler electronic transmission of HIPAA standard transactions Standard unique health identifiers for health care providers, health plans, and employers More efficient coordination of benefits transactions. Who can apply for the NPI? What is a HIPAA-covered health care provider? It is a health care provider who transmits any health information in electronic form in connection with a transaction for which the Secretary of HHS has adopted a standard, even if the health care provider uses a business associate to do so. Go to http://www.cms.hhs.gov/HIPAAGenInfo/Downloads/CoveredEntitycharts.pdf to access a tool to help establish whether one is a covered entity. Who cannot receive an NPI? Atypical providers are not eligible to receive an NPI. An atypical provider is any entity that does not meet the definition of a “health care provider” at 45 CFR 160.103, This includes but is not limited to billing services, value-added networks, re-pricers, health care clearinghouses, non-emergency transportation services, and others. How to get and report an NPI? Getting your NPI Reporting your NPI: Providers should report their NPI to the IHCP using the online NPI Reporting Tool or by submitting the paper NPI Reporting Form. For online submission of the NPI, please see the NPI Reporting Tool User Guide HIPAA covered entities such as health care providers who conduct HIPAA standard transactions, health care clearinghouses, and all health plans must use ONLY the NPI to identify HIPAA covered health care providers in standard transactions by May 23, 2008. A healthcare provider’s claims submitted without an NPI on or after May 23, 2008, will be rejected.

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