National Provider Identifier; Who Needs It and Why

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Each industry has a set of requirements designed to facilitate streamlined operation, and in healthcare corridors, among such concerns is the National Provider Identifier (NPI). NPI search is a common practice in the health care industry. If you haven’t given it a thought, here is a quick rundown to help you understand what it is and why you need it.

What is NPI?

NPI is a 10-digit number used to identify an individual or organization to their health care partners such as clearinghouses, payers, and vendors in HIPAA ((Health Insurance Portability and Accountability Act)) standard transactions. NPI is categorized into two; Type one (individuals) and Type 2 (organizations). Type one includes individuals such as physicians, sole proprietors, dentists, chiropractors, nurses, physical therapists, among others. You are eligible for only one NPI under the Type 1 category.

Type 2 includes organizations such as hospitals, clinics, ambulance companies, laboratories, group practices, HMOs (health maintenance organizations), nursing homes, and pharmacies, among others. Under Type 2, you can get more than one NPI. If you determine that you have a subpart in your health care organization, you can apply for a separate NPI. For instance, if you are a health care provider who’s also incorporated, you can apply for Type 1 NPI and Type 2 for the corporation.

Who needs it?

An individual or organization delivering health care services as defined in 45 code of Federal Regulations (CFR) 160.103 can apply for NPI. You can be eligible but overlook it; however, it is a must-have if you are HIPAA covered. Whether you are an individual or organization, if you are HIPAA covered, or bills Medicare for your services, NPI is a must-have. The Administrative Simplification mandate of HIPAA facilitates efficient coordination with the relevant stakeholders in the healthcare industry.

How can you get NPI?

You can obtain NPI through;

  • Online application by visiting the NPPES website and completing the online application
  • Form submission: Download paper application from The Centers for Medicare and Medicaid Services (CMS) website, fill it and mail it to the provided address.
  • Authorize an employer, trusted organization, or Electronic File Interchange (EFI) to apply for the NPI through the bulk enumeration.

NPI was created to improve the effectiveness and efficiency of the electronic transmission of health information. The simplification makes it easier for various stakeholders to coordinate while adhering to the set standards. CMS developed NPPES (National Plan and Provider Enumeration System) to assign the NPI. The simplification replaced identifiers previously used in HIPAA standard transactions, including those used with Medicare and other health plans. Today, you need NPI before enrolling with Medicare, stressing every healthcare provider’s need to apply.

With hundreds of thousands of NPI searches undertaken by various people, you might be concerned that you are exposed. However, NPI doesn’t hold your personal information such as residence, where you practice, specialization field, or provider type, among other details. NPI doesn’t change, and it doesn’t have an expiry date. Once you get it, even if you modify your name, taxonomy, or location, it won’t change.