Smart Talk: What's an NPI?

Thursday, June 30, 2005

Q. What is a "National Provider Identifier" and why should I care?
A. The NPI is the "National Provider Identifier." It is ten digit number the will be used by all medical service providers for identification to all payors (not just government payors) replacing the individual provider numbers issued by each payor. Although it is not required for two years, you should apply now. Failure to comply appropriately could result in loss of ability to bill payors and/or the imposition of fines.
In 1996, Congress passed the Health Insurance Portability and Accountability Act ("HIPAA") which included a requirement that CMS implement a system to simplify and promote electronic data exchange. The NPI is a component of CMS' response to this requirement.
All providers (including DME, respiratory, pharmacy, enteral, and prosthetic/orthotic suppliers) are required to submit claims using their NPI number by May 23, 2007. All payors are required to accept the NPI numbers by May 23, 2007, except for small payors, which do not have to comply with until May 23, 2008. Each payor will let you know when they are ready to accept the NPI numbers. Although you may (and should) get your NPI number now (and avoid the inevitable rush and delay), you may not use your NPI number until the payors tell you that they are ready to receive electronic transmissions using the NPI number. Once it is assigned, your NPI number will not expire.
You can obtain your NPI number in one of three ways. First. You can complete an online application. Second. You can submit a paper application. Third. With your permission, an entity with which you are affiliated can submit your name for an NPI number.
Without an NPI number you cannot submit claims to most payors after March 23, 2007. If you provide false information during the application process, you could be liable for a fine of up to $500,000. If you have any questions about the NPI number contact an attorney familiar with health care regulatory issues.


Richard Tuten is an attorney with the Health Law Center,