Your National Provider Identifier: Get It and Use It

Starting on May 23, your National Provider Identifier (NPI) will be the only identifier that most health plans, both public and private, will use to identify you in all standard transactions such as claims, coordination of benefits transactions, enrollment in health plan networks, etc. (Smaller health entities will have until May 23, 2008, to start using the NPI.)

The NPI, mandated by the Health Insurance Portability and Accountability Act of 1996, replaces the Uniform Provider Identification Number (UPIN), currently required under Medicare, and other identifying numbers assigned by insurers. The NPI functions much like a Social Security number—it is yours for life and will never be assigned to another provider. The only time it will be changed is in the case of identity theft.

NPIs are issued through the National Plan and Provider Enumeration System (NPPES), developed by the Centers for Medicare and Medicaid Services (CMS). NPPES can can be accessed online at<https://nppes.cms.hhs.gov/NPPES/Welcome.do>, where you will find information on NPIs and an application form. you can fill out and submit the application online or obtain a hard copy by calling (800) 465-3203.

The application form takes about 20 minutes to complete. Individual providers are asked to provide name, Social Security number (or ITIN for those not eligible for a Social Security number), date of birth, country of birth, state of birth (if born in the United States), gender, mailing address, address and phone number of practice, taxonomy (for psychiatrist, the code is 2084P0800X; the online form has a pop-up box that allows users to select the correct code), state medical license information, and a contact person's name, phone number, and e-mail address.

Since October 2, 2006, CMS has permitted Medicare providers to submit electronic claims using only their NPI, although CMS recommends that providers include their UPIN as well. Use of NPIs on paper claims began on January 2.

If you submit paper claims, be sure to use the revised form CMS-1500 that includes a block for the NPI. Be aware that if you enter your NPI in block 33 on the old CMS-1500 claim form, the claim will be rejected.

More information on NPIs is posted on the CMS Web site at<www.cms.hhs.gov/NationalProvIdentStand/>. Check that site periodically for updates. ▪