National Provider Identifier Information (NPI)

On April 2nd, 2007, the provision of the Administrative Simplification involving the implementation of National Provider Identifier (NPI) numbers will become mandatory.Historically, healthcare providers are identified by an association with a Tax ID, a billing group, a practice location, a specific contract, or a combination of identifiers. Frequently, healthcare providers have used different identifiers for the same practice in order to differentiate contracts with a payer. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 decided to enact policy to simplify and standardize this identification process by assigning each health care provider a unique identifier, an NPI number, for use with all health care plans and payers. HIPAA predicts administrative simplification savings to come from this reduction of provider identities.Starting on January 1st, 2007, the HCFA form will include new fields for these identifiers on lines 17b, 32a, and 3a. While use of the NPI number is optional until March 30, 2007, healthcare providers should apply for an NPI as soon as possible, regardless of whether or not they are a covered entity. Between January 1st and March 30th, providers should use their NPI as well as their old identification scheme in order to ease the transition, especially in the 837 claims. Payers are responsible for building their own identity mapping table to correlate the provider NPI to their identification information; however, practices can aid this process by sending “change of identifier” notifications to payers, similar to “change of address” cards.LeonardoMD is ready for the transition, providing support for both NPI as well as traditional identification schemes. Once your practice has registered for an NPI, LeonardoMD provides the tools and services necessary to seamlessly incorporate this method into the daily administration of your practice, automating the transition process to ensure a simple and undemanding compliance with the most current HIPAA standards.References:HIPAA Administrative Simplification: Standard Unique Identifier for Health Care Providers:Click HereOffice of the Secretary, Dept of Health and Human Services. 45 CFR Part 162: HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule. Federal Register, Vol 69, No 15. January 23, 2004.Dept of Health and Human Services. National Plan and Provider Enumerations System (NPPES). https://nppes.cms.hhs.gov/. Accessed March 21, 2006.Zubeldia, Kepa. NPI Transition Plan. http://www.claredi.com/. April 5, 2004.