NHIC

For the most up to date information, including information on the Medicare Fee-for-Service contingency plan, go to the CMS website at: www.cms.hhs.gov/NationalProvIdentStand (CMS Message 200705-28)

The comprehensive source for Medicare National Provider Identifiers (NPI):

NPI Registry-National Plan & Provider Enumeration System (NPPES)

Important CMS Announcements

The NPI will be Required for all HIPAA Standard Transactions on May 23^rd

As of May 23, 2008, the NPI will be required for all HIPAA standard transactions. This means:

For 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.
The reporting of Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction.

REMINDER: May 23^rd is Only Two Months Away, Be Prepared!

TEST NPI-only NOW

Now that the NPI is required on all Medicare claims in the primary provider fields, if your claims are being successfully processed with NPI/legacy pairs (and most are) now is the time to begin testing claims using the NPI alone. If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, go into your NPPES record and validate that the information you are sending on the claim is consistent with the information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem.

Call the Customer Service Representative at your Medicare carrier, FI, or A/B MAC enrollment staff or your DME MAC to discuss your situation and, if necessary, have it investigated. Have a copy of your NPPES record or your NPI Registry record available. The contractor telephone numbers are likely to be quite busy, so don't wait.

Doing this testing now will allow time for any needed corrections prior to May 23, 2008, the date when only the NPI will be accepted in all provider fields.

What is the NPI?

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.

All HIPAA covered healthcare providers, whether they are individuals or organizations, must obtain an NPI for use to identify themselves in HIPAA standard transactions. Once enumerated, a provider's NPI will not change. The NPI remains with the provider regardless of job or location changes.

HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the NPI to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008.

After the above compliance dates, health care providers may use only their NPIs to identify themselves in standard transactions, where the NPI is required.

NPI Updates

NPI Related MLN Matters Articles
Check the FAQ's for billing tips using NPI, as well as the 1500 Billing Guide in the publications section of this website.

NPI Web Sites

National Provider Identifier (NPI) Information for Medicare Fee-for-Service Provider
The CMS website page that consolidates all information on the NPI. Although the NPI information and educational materials on this web page have been developed for Medicare FFS providers, these resources may be useful to other health care providers.
National Plan and Provider Enumeration System (NPPES) :
The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. CMS has contracted with Fox Systems, Inc. to serve as the NPI Enumerator. The NPI Enumerator is responsible for dealing with health plans and providers on issues relating to unique identification.
Health Insurance Portability and Accountability Act (HIPAA) --- Identifiers & Standards
Includes all HIPAA Administrative Simplification information, including Frequently Asked Questions, NPI Final Rule, System of Records Notice, Announcements of Roundtables and industry events.
Workgroup for Electronic Data Interchange (WEDI)
An organization with whom the Secretary must consult when developing any of the HIPAA Administrative Simplification (AS) standards. WEDI has published several White Papers on the NPI, accessible through its website.

03/27/2008