The Nationwide Provider Identifier (NPI) is a HIPAA-mandated national standard for usage in the health-care business that was adopted by the Secretary of Health and Human Services.
All covered providers, clearinghouses, and health plans (excluding extremely small health plans, which have an extra year) must have completed their NPI changeover process by May 23, 2007.
The NPI is more than just a new number. NPI implementation is complicated because it is required for authorizations, invoicing, payment, care coordination, reporting, and other functions. The first step in the implementation procedure is to obtain your NPI.
What is the National Provider Identifier
The NPI is a new 10-digit identification number provided by the federal government to individuals, small and big provider organizations, and other entities.
The 10-digit ID is “intelligent-free,” in the sense that it contains no coded information and does not communicate specific features of the health-care provider it identifies.
A provider’s NPI will not change once it has been assigned. Except in specific cases, such as when an individual provider retires, an organization provider ceases to exist, or a provider’s NPI is being used fraudulently, it will remain the same regardless of location, area of practice, or any other factor.
For health care providers who are mentioned and reported in HIPAA standard transactions, the NPI must be used as the only identifier. Health care claims, claim payments, eligibility, and referrals are all HIPAA standard procedures.
NPI will NOT Replace Your Tax ID
When the Tax ID (SSN or EIN) is required to be reported in claims for tax purposes, the NPI will NOT be used to substitute it.
Individuals’ tax ID numbers are their Social Security numbers, whereas organizations’ tax ID numbers are their Employer ID Numbers provided by the IRS.
After May 23, 2007, along with the NPI, the Tax ID will be the only extra ID permitted to be reported, and only in appropriate places, such as to identify the Billing/Payto Provider for tax reporting purposes via IRS 1099 forms.
Certain licence, certification, registration, and similar numbers may be required on some claims and are permitted to be disclosed for the purposes for which they were issued.
As a result, if those numbers are required in HIPAA standard transactions, NPI cannot be used in place of them. Two examples are the CLIA number and the Mammography Certification Number.