N ational P rovider I dentifier Type 1 Workforce Training Month Day, Year The NPI will become the standard, unique identifier for health care providers in HIPAA Transactions
DHHS/DIRM Projects Office - NPI Initiative 2 Purpose This training presentation is being delivered to educate workforce members on –National Provider Identifier Requirement –How to Obtain an NPI –How to Report NPI to Facility/Division –NPI Resources Available
DHHS/DIRM Projects Office - NPI Initiative 3 National Provider Identifier Requirement
DHHS/DIRM Projects Office - NPI Initiative 4 Background The NPI is a HIPAA Administrative Simplification Standard –Transactions and Code Sets –Security –Privacy –Identifiers Unique Employer Identifier Unique Health Care Provider Identifier (NPI) Unique Health Plan Identifier – Proposed rule pending
DHHS/DIRM Projects Office - NPI Initiative 5 Published January 23, 2004 Requires the use of the NPI in standard transactions to identify health care providers standard transactions no later than 5/23/07 Replaces the use of proprietary and legacy provider identifiers in standard transactions –Unique Physician Identification Number (UPIN) –Medicaid ID –Medicare ID –BCBS, Aetna, etc. IDs NPI Final Rule
DHHS/DIRM Projects Office - NPI Initiative 6 Placed requirements on HIPAA covered entities –Health plans (e.g., Medicare, NC Medicaid, BCBS) –Health care clearinghouses –Health care providers conducting HIPAA standard transactions DMH/DD/SAS facilities DPH State Lab and CDSAs OES Schools NPI Final Rule – cont’d
DHHS/DIRM Projects Office - NPI Initiative 7 All health care providers who conduct any of the HIPAA standard transactions –Individuals – NPI Type 1 These individuals furnish health care services that are billed using HIPAA standard electronic transactions or may initiate and / or receive referrals. This includes: –DHHS Workforce Members –Private Providers –Organizations – NPI Type 2 –Organization “Subparts” – NPI Type 2 Components of organizations that conduct transactions separately from the rest of the organization Note – all “health care providers” as defined by are eligible for NPI Who Must Get an NPI?
DHHS/DIRM Projects Office - NPI Initiative 8 List Provider Types Here Who Must Get an NPI in This Facility?
DHHS/DIRM Projects Office - NPI Initiative 9 What is an NPI? 10 digit number All numeric Never changes –Good for the life of the provider –May be deactivated/reactivated Does not itself convey information about the provider –Legacy provider numbers may have “intelligence” that describes the provider type, specialty, and location
DHHS/DIRM Projects Office - NPI Initiative 10 Who Assigns NPIs? NPI Enumerator – HHS contracted with Fox Systems, Inc. –Process applications and assigns NPIs –Maintains NPI data in the National Plan and Provider Enumeration System (NPPES) –Furnishes NPI information upon request and in accordance with established guidelines Privacy Policy available at
DHHS/DIRM Projects Office - NPI Initiative 11 DHHS Approach to Workforce Enumeration DHHS HIPAA Oversight Committee Recommendation –DHHS not assume the responsibility to submit NPI applications for workforce members –Memo sent to DHHS Division Directors April 2006 ( dentifiers/identifiers.html) DHHS Policy under development to support decision
DHHS/DIRM Projects Office - NPI Initiative 12 Requirements for DHHS Workforce DHHS workforce members must –Apply for NPI by schedule required by facility/division –Report NPI data to facility/division NPI Contact –Maintain data supplied to obtain NPI changes Updates to be made within 30 days of change –Report appropriate changes to facility/division NPI Contact
DHHS/DIRM Projects Office - NPI Initiative 13 How to Obtain an NPI
DHHS/DIRM Projects Office - NPI Initiative 14 Before You Apply Collect the following information –SSN or Individual Taxpayer Identification Number –Date of Birth –Country of Birth –State of Birth (if Country of Birth is U.S.) –Gender –Mailing Address –Practice Location Address and Phone Number –Taxonomy Code(s) –State License or Certification Information (required for certain Taxonomy Codes) –Contact Phone Number and Address
DHHS/DIRM Projects Office - NPI Initiative 15 Taxonomy Codes Explained An additional, unique, 10 position number to be listed on NPI application –Minimum of one required; up to 14 allowable –Some require license/certification number Provides additional information on provider (replaces missing legacy ID “intelligence”) –Provider Type –Classification –Area of Specialization Situational use on transactions – requirement TBD by each health plan –DHHS assuming all plans will require Taxonomy Code list available at –Use “Individual or Groups (of Individuals)” list
DHHS/DIRM Projects Office - NPI Initiative 16 Taxonomy Codes – cont’d
DHHS/DIRM Projects Office - NPI Initiative 17 How to Apply Two options available at –Paper Form Make a copy before mailing Keep notification letter of assigned NPI –Electronic Form – Recommended Self-assigned ID and Password – store in safe place Print every page before advancing Keep notification of assigned NPI Helpful HINT: Review CMS NPI Viewlet before applying! –
DHHS/DIRM Projects Office - NPI Initiative 18 How to Report NPI Data to Facility/Division
DHHS/DIRM Projects Office - NPI Initiative 19 What to Report Provide a copy of the NPI assignment letter/ Include Taxonomy Code(s) listed on application Give to NPI Contact designated by your Facility or Division
DHHS/DIRM Projects Office - NPI Initiative 20 Your NPI Contacts Are Name –Phone – Address –MSC Code Name –Phone – Address –MSC Code
DHHS/DIRM Projects Office - NPI Initiative 21 Reporting Schedule Facility/Division Schedule to be inserted here
DHHS/DIRM Projects Office - NPI Initiative 22 NPI Resources Available
DHHS/DIRM Projects Office - NPI Initiative 23 NPI Resources Centers for Medicare and Medicaid Services (CMS) – w.asp DHHS HIPAA Web Site – tifiers/identifiers.html –Contains Helpful Hints, FAQs, and other useful information
DHHS/DIRM Projects Office - NPI Initiative 24 NPI Resources – cont’d NPI Enumerator – – or TTY –Can provide copies of NPI notification letter if lost