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NPI and the New Medicare Provider Enrollment Process (GEN) - Revised 5-22-08
Posted May 22, 2008
On February 1, 2008, the Centers for Medicare & Medicaid Services (CMS) revised the CMS 855 Medicare provider enrollment applications. If you are enrolled in Medicare, but have not submitted a CMS 855 since 2003, you are required to submit a complete application. Providers and suppliers should follow the instructions for completing an initial enrollment application. As part of the revised enrollment process, initial enrollees and existing enrollees making changes to their enrollment information must include their National Provider Identifier (NPI) number. The information submitted to the National Plan and Provider Enumeration System (NPPES) must match your information on file with the Social Security Administration and/or the Internal Revenue Service for a Tax Identification Number (TIN). No initial application can be approved and no updates to existing enrollment information can be made without this NPI information. All health care providers and suppliers who bill Medicare are required to obtain their NPI in advance of enrolling in or changing their Medicare enrollment data.
If you are an individual or sole proprietor, who furnishes health care, you are eligible for one and only one NPI. If you are an individual who is a health care provider and who is incorporated, you may need to obtain an NPI for yourself and an NPI for your corporation or LLC. If you are an organization that furnishes health care, you may determine that you have components, called “subparts,” that need their own NPI. For additional information about the NPI, please go to www.cms.hhs.gov/NationalProvIdentStand/.
An information sheet designed to provide basic information about the NPI, including the three different ways to apply for your NPI is available at www.cms.hhs.gov/MedicareProviderSupEnroll/ downloads/EnrollmentSheet_WWWWH.pdf. Whatever method you use to obtain your NPI, be sure to keep this information, share it with your health care partners, and update your information with NPPES whenever any of the information used to get your NPI changes.
Starting May 23, 2007, the NPI will replace all of your existing provider numbers that you use to bill Medicare, Medicaid, and other health care payers.
For more information about the revised provider enrollment process, please contact your Medicare contractor or go to www.cms.hhs.gov/MedicareProviderSupEnroll. |
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