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CMS Announces the National Provider Identifier (NPI) Enumerator Contractor and Information on Obtaining NPIs (GEN)
Posted May 11, 2007
Medlearn Matters Number: SE0528
Related Change Request (CR) #: N/A
Related CR Release Date: N/A
This article was revised on May 7, 2007, to add this statement that Medicare Fee-for-Service (FFS) has announced a contingency plan regarding the May 23, 2007, implementation of the National Provider Identifier (NPI). For some period after May 23, 2007, Medicare FFS will allow continued use of legacy numbers on transactions; accept transactions with only NPIs; and accept transactions with both legacy numbers and NPIs. For details of this contingency plan, see the MLN Matters article MM5595 at www.cms.hhs.gov/MLNMattersArticles/downloads/MM5595.pdf on the Centers for Medicare & Medicaid Services (CMS) Web site.
Provider Types Affected
All health care providers – Medicare and non-Medicare.
Provider Action Needed
Learn about the NPI and how and when to apply for one.
Background
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of a new health care identifier for use in the HIPAA standard transactions.
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 advices.
The NPI will replace health care provider 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.
Important Note: While you are urged to apply for an NPI beginning May 23, 2005, the Medicare program is not accepting the NPI in standard transactions yet. Explicit instructions on time frames and implementation of the NPI for Medicare billing will be issued later in 2006.
NPI Enumerator Contract Awarded
Recently, CMS announced the selection of Fox Systems, Inc. as the contractor, to be called the Enumerator, to perform the support operations for the NPI project.
Fox Systems, Inc. will process NPI applications from health care providers and operate a help desk to assist health care providers in obtaining their NPIs.
Who may apply for the NPI?
All health care providers, including individuals, such as physicians, dentists, and pharmacists, and organizations, such as hospitals, nursing homes, pharmacies, and group practices, are eligible to apply for and receive an NPI. Note: All health care providers who transmit health information electronically in connection with any of the HIPAA standard transactions are required by the NPI Final Rule to obtain NPIs. This is true even if they use business associates such as billing agencies to prepare the transactions.
The NPI Application Process
Health care providers may begin applying for an NPI on May 23, 2005. Once the process begins, it will be important to apply for your NPI before the compliance date of May 2007, because health plans could require you to use your NPI before that date.
You will be able to apply for your NPI in one of three ways:
- You may apply through an easy-to-use Web-based application process, beginning May 23, 2005. The Web address will be https://nppes.cms.hhs.gov, but please note – the Web site is not available until May 23, 2005.
- Beginning July 1, 2005, you may complete a paper application and send it to the Enumerator. A copy of the application, including the Enumerator’s mailing address (where you will send it) will be available on https://nppes.cms.hhs.gov, or you can call the Enumerator to receive a copy. The phone number is 800-465-3203 or TTY 800-692-2326. But remember, paper applications may not be submitted until July 1, 2005.
- With your permission, an organization may submit your application in an electronic file. This could mean that a professional association, or perhaps a health care provider who is your employer, could submit an electronic file containing your information and the information of other health care providers. This process will be available in the fall of 2005.
You may apply for an NPI using only one of these methods. When gathering information for your application, be sure that all of your information, such as your social security number and the Federal Employer Identification Number, are correct. Once you receive your NPI, safeguard its use.
If all information is complete and accurate, the Web-based process could result in you being issued a number within minutes. If there are problems with the information received, it could take longer. The paper application processing time is more difficult to estimate, depending on the information supplied in the application, the workload, and other factors.
The transition from existing health care provider identifiers to NPIs will occur over the next couple of years. Each health plan with which you conduct business, including Medicare, will notify you when it will be ready to accept NPIs in standard transactions, like claims. You can expect to hear about the importance of applying for an NPI from a variety of sources. Be clear that you only have to apply for, and acquire, one NPI. Your unique NPI will be used for all standard transactions, Medicare and non-Medicare.
Please be particularly aware that applying for an NPI does not replace any enrollment or credentialing processes with any health plans, including Medicare.
Additional Information
For additional information on NPIs:
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. |
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