About the NPI
To improve the efficiency and effectiveness of the health care system, Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) of 1996, which included a series of “administrative simplification” provisions that required the Department of Health and Human Services (HHS) to adopt national standards for electronic health care transactions and code sets and identifiers to be used in those transactions.
On January 23, 2004, HHS adopted the National Provider Identifier (NPI) as the unique identifier for healthcare providers, replacing the legacy numbers currently used in HIPAA standard transactions with Medicare and other payers. Any provider subject to HIPAA regulations must acquire an NPI and send it to any entity, such as CareMedic, that will use it to identify the provider in standard transactions.
On April 2, 2007, CMS announced that it was implementing a contingency plan for providers who could not meet the May 23, 2007, deadline. This contingency plan, in effect, extended the dual usage period to May 23, 2008, if certain conditions were met. The NPI final rule is clear: May 23, 2007, is the final deadline for covered entities, other than small plans, to comply with HIPAA’s NPI provisions. However, for a 12-month period after the compliance date (i.e., through May 23, 2008), CMS did not impose penalties on covered entities that deployed contingency plans (in order to ensure the smooth flow of payments) if they made reasonable and diligent efforts to become compliant and, in the case of health plans (that are not small health plans), to facilitate the compliance of their trading partners. Specifically, as long as a health plan (that is not a small health plan) can demonstrate to CMS its active outreach/testing efforts, it can continue processing payments to providers.
After May 23rd, within all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice. PLEASE NOTE: Any claim reporting Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction.
Last updated on May 28, 2008
