Over 1.4M National Provider Identifiers (NPIs) have been issued. Do you have yours?

Think you don’t need an NPI? Think again, and be sure. If you are a health care provider who bills for services, you probably do need an NPI. If you bill Medicare for services, you definitely do!

The bad news is that as of November 23, only six months remain until the NPI compliance date. The implementation of the NPI is a complex process that will impact all business functions of your practice, office, or institution including: billing, reporting, and payment. This is why providers are urged to get, share, and use their NPI NOW to avoid a disruption in cash flow.

If you don’t have an NPI, get one. If you have one, start the testing process with your health plan and use it on your claims and other transactions.

The Centers for Medicare & Medicaid Services (CMS) continues to urge providers to include legacy identifiers on their NPI applications. This information is critical for health plans and health care clearinghouses in the development of crosswalks to aid in the transition to the NPI.

Key NPI Facts
The Centers for Medicare & Medicaid Services (CMS), along with the Workgroup for Electronic Data Interchange (WEDI) and other industry health plans, would like to remind providers of the following key NPI facts:

• Every covered health care provider must get and use the NPI; and even if a health care provider is an individual and is not conducting electronic transactions and is, therefore, not a covered provider, he or she may be required by health plans or employers to obtain an NPI.
• The NPI is not just a number. It does affect internal and external business and systems operations and can affect the appropriate payment of claims in a timely manner.
• It is estimated that use of the NPI can require a transition period of no less than 120 days.
• Providers should begin to test and use their NPIs in electronic health care transactions no later than January 31, 2007.
• May 23, 2007 is not when the process starts, but when the process must be completed.
• Providers may be requested to communicate their NPIs to health plans, clearinghouses, and other providers well before the compliance date.
• A health care provider who is a sole proprietor is considered an individual and can only have ONE NPI.

Sharing NPIs
Once providers have received their NPIs, they should share their NPIs with other providers with whom they do business, and with health plans that request it. In fact, as outlined in current regulation, all providers must share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes -- including designation of ordering or referring physician. Providers should also consider letting health plans, or institutions for whom they work, share their numbers for them.

NPIs are FREE!
Health care providers should know that getting an NPI is free. You do not need to pay an outside source to obtain your NPI for you. All CMS education on the NPI is also free. CMS does not charge for its education or materials.

NPI Questions
CMS continues to update our Frequently Asked Questions (FAQs) to answer many of the NPI questions we receive on a daily basis. Visit the following link to view all NPI FAQs:

http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=Qjr3YRYh&p_lva=&p_li=&p_page=
1&p_cv=&p_pv=&p_prods=0&p_cats=&p_hidden_prods=&prod_lvl1=0&p_search_text=NPI&p_new_search=
1&p_search_type=answers.search_nl .

Providers should remember that the NPI Enumerator can only answer/address the following types of questions/issues:

• Status of an application
• Forgotten/lost NPI
• Lost NPI notification letter
• Trouble accessing NPPES
• Forgotten password/User ID
• Need to request a paper application
• Need clarification on information that is to be supplied in the NPI application

Providers needing this type of assistance may contact the enumerator at 1-800-465-3203.

Upcoming WEDI Events
WEDI has several NPI events scheduled in the upcoming month. Visit http://www.wedi.org/npioi/index.shtml to learn more about these events. Please note that there is a charge to participate in WEDI events. 

Important Information for Medicare Providers

Communicating NPIs to Medicare
Medicare providers should know that there is no “special process” or need to call to communicate NPIs to the Medicare program. NPIs can be shared with the Medicare Program in three different ways, as part of the following standard procedures:

• Medicare providers should use their NPI, along with appropriate legacy identifiers, on their Medicare claims.
• For new Medicare providers, an NPI must be included on the CMS-855 enrollment application.
• Existing Medicare providers must provide their NPIs when making any changes to their Medicare enrollment information.

Still Confused?
Not sure what an NPI is and how you can get it, share it, and use it? As always, more information and education on the NPI can be found at the CMS NPI Web page, www.cms.hhs.gov/NationalProvIdentStand, on the CMS Web site. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.

Getting an NPI is free - not having one can be costly.

CMS Learn Resource 200611-15

Posted: 11/22/2006

CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.