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| National Provider Identifier |
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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. On January 23, 2004, the Secretary published a Final Rule that adopted the National Provider Identifier (NPI) as this identifier.
The NPI must be used by covered entities under HIPAA (generally, health plans, health care clearinghouses, and health care providers that conduct standard transactions). The NPI will identify health care providers in the electronic transactions for which the Secretary has adopted standards (the standard transactions) after the compliance dates. These transactions include claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance advice.
The NPI will replace health care provider identifiers (also refered to as legacy identifiers) that are in use today in standard transactions. Implementation of the NPI will eliminate the need for health care providers to use different identification numbers to identify themselves when conducting HIPAA standard transactions with multiple health plans.
All health plans (including Medicare, Medicaid, and private health plans) and all health care clearinghouses must accept and use NPIs in standard transactions by May 23, 2007 (small health plans have until May 23, 2008). After those compliance dates, health care providers will use only their NPIs to identify themselves in standard transactions, where the NPI is required.
NPI will be implemented in three stages. Stage 1 will be implemented beginning January 3, 2006, and continue through October 1, 2006. Stage 2 will begin on October 2, 2006, and run through May 22, 2007. Stage 3 will begin on May 23, 2007.
For more information on NPI and each of the three stages, visit the following NPI sections of our Web site. Within the section for each stage, you will find information regarding the stage of implementation, as well as HIPAA edits for each stage.
- General NPI Information - General articles and information relating to NPI as a whole.
- Stage 1 - January 3, 2006 - October 1, 2006 - Highlights and articles regarding Stage 1 of the NPI implementation.
- Stage 2 - October 2, 2006 - May 22, 2007 - Highlights and articles regarding Stage 2 of the NPI implementation.
- Stage 3 - May 23, 2007 - Forward - Highlights and articles regarding Stage 3 of the NPI implementation.
- NPI Links - Links to NPI resources.
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