NPI is the acronym for the National Provider Identifier. It is one provision of the administrative simplification portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The NPI is required in electronic exchanges of HIPAA transactions. You can continue to use existing identification numbers in paper and non-HIPAA electronic transactions after the mandatory compliance date. The NPI mandate does allow payers, however, to require the use of the NPI on all transactions, including paper, to improve processing efficiency.

We expect all network providers to obtain NPIs whether filing electronically or via paper.

No. In addition to hospitals and physicians, NPIs are issued to institutional and other healthcare providers, such as:

• Skilled nursing facilities
• Home health agencies
• Comprehensive outpatient rehabilitation facilities
• Assorted clinics and centers
• Clinical laboratories
• Residents
• Various licensed/certified healthcare practitioners
• Suppliers of durable medical equipment

They also are issued to any appropriately licensed or certified healthcare practitioners or organizations, including pharmacies, nursing homes and many types of therapists, technicians, aides and any other individual or organization that furnishes healthcare services or supplies. In other words, an NPI applies to any healthcare individual or organization that bills and is paid for healthcare services or supplies. If organizations such as hospitals are made up of components, or separate physical locations that qualify as separate healthcare facilities, each location is issued its own NPI. These types of arrangements are referred to as "sub-parts" in the NPI Final Rule.

The NPI is a 10-digit numeric field that includes one check digit in the tenth position to ensure accuracy. This format will permit 200 billion unique identifiers to be issued without re-using the same values. The NPI contains NO imbedded intelligence. In other words, you cannot determine a provider’s state, region, specialty or any other information directly from his or her NPI.

The NPI is generated by a new system called the National Plan and Provider Enumeration System (NPPES) and issued by the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare and Medicaid Services (CMS).

Providers can apply to CMS for an NPI and must have an NPI by May 23, 2007 when exchanging electronic transactions (small health plans have until May 23, 2008). Applications are available on the CMS Web site. Providers must supply adequate information to ensure they can be identified uniquely by the National Plan and Provider Enumeration System (NPPES). Should any of that information change in the future, providers must notify CMS within 30 days.

Even if a provider moves, changes specialty, or changes practices, the provider will retain the same NPI, but must notify CMS and supply the new information. The NPI is intended to identify the provider throughout his or her career. Organization NPIs also are intended to be permanent except in rare situations such as when a healthcare provider does not wish to continue an association with a previously used NPI, or when a healthcare provider's NPI has been used fraudulently by another.

Our NPI project development program has established project teams throughout its organization. These teams are dedicated to researching the issues, assessing systems, reviewing business processes and educating our organization about implementation procedures while helping to ensure an understanding of the expected end result.

Provider outreach is also a crucial piece in successful NPI implementation.  Provider Relations and Education representatives are working with providers and collecting NPI feedback during scheduled visits.

In May 2005, CMS issued a "Dear Provider Letter." This letter briefly outlines the application process and the various ways the provider may obtain an NPI.  You will also find a copy of this letter on our site in the HIPAA Critical Center.

Providers can apply electronically now through the CMS Web-based application system. Providers who prefer to use the paper format can call the enumerator at 1-800-465-3203 for a copy. A copy of the application and the enumerator’s address will be available at the same Web site. Also, the provider may choose to submit his or her application through an organization, professional association or employer, known as Electronic File Interchange (EFI), or Bulk Enumeration.

Up-to-date information regarding the NPI is available on the NPPES Web site. You may also contact the enumerator by telephone at 1-800-465-3203 or TTY 1-800-692-2326. In addition, an instructional NPI Web tool is now available on the CMS Web site.