What is the purpose of the National Provider Identifier (NPI)? Who uses it and when? The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions by the compliance dates. The compliance date for all covered entities except small health plans was May 23, 2007; the compliance date for small health plans was May 23, 2008. As of the compliance dates, the NPI will be the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities. What is the National Provider Identifier (NPI) compliance date? The compliance date for use of the NPI in HIPAA transactions was May 23, 2007. To accommodate industry issues with implementation of the NPI, CMS provided guidance on April 2, 2007 to allow covered entities to execute contingency plans. In the guidance document, CMS announced that through May 23, 2008, it would not impose penalties on covered entities that deploy contingency plans to facilitate the compliance of their trading partners. Effective May 24, 2008, CMS has lifted its enforcement leniency policy. Complaints will be investigated as they are today, but penalties will be a legitimate resolution if the entity does not demonstrate compliance or corrective action. CMS will continue to employ a complaint driven approach to enforcement. For example, if a complaint is received alleging a failure to comply with the NPI requirements, CMS will contact the entity to secure evidence of compliance and the contingency plan that had been in place. If violations are identified, enforcement actions will take place. All contingency plans should now be complete and all covered entities are expected to submit and accept the NPI on standard electronic transactions’ What is the fastest way that a health care provider can obtain a National Provider Identifier (NPI)? The web-based NPI application process is the fastest and most efficient way for a health care provider to obtain an NPI. To apply:https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions If you apply via online, and haven’t received the NPI Notification, first check the computer’s SPAM filter to ensure that the NPI Notification e-mail has not been routed to SPAM. If the NPI Notification is not in the SPAM filter and it has been 15 days since the NPI application was submitted online, the health care provider or the Contact Person should contact the NPI Enumerator at 1-800-465-3203. What is the format of the National Provider Identifier (NPI)? How is CareMedic going to validate the NPI numbers submitted? The National Provider Identifier (NPI) is all numeric and is 10 positions in length: the first 9 positions are the identifier and the last position is a check digit. The check digit helps detect invalid NPIs. There is no embedded intelligence in the NPI with respect to the health care provider that it identifies. Caremedic will verify the check digit to ensure the NPI is valid. When will CareMedic be able to support submission of NPI only? As of May 23rd, 2008, Caremedic fully supports the submission of NPI only. How do I contact Caremedic with questions about the NPI? If you have any NPI related questions, please email support@caremedic.com or contact your CareMedic Customer Support Representative at (800)-761-9830. If you have any further questions regarding National Provider Identifiers (NPI) please visit the Centers for Medicare and Medicaid Services (CMS) Frequently Asked Questions Page: http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=YB3IQSYh Last updated on May 28, 2008
"Ultimately, we reduced write-offs, achieved our post conversion net revenue target, reduced days in A/R, increased cash collections and reduced our open accounts." ---Debbie Messina Manager, Patient Access and Business Services Stamford Hospital
