Q: I am being asked to produce or give my "NPI" by many insurance carriers. What is the NPI, and do I have to show something in addition to my license number for billing?
A: The assignment of a National Provider Identifier, or NPI, is another step from the administrative simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).The provision is mandated to make a single, unique identifier for health care providers and health plans.
The ideal is to have one standard number for each health care provider to use for all health care plans. Consider that under the current system, you likely are using several different numbers to identify you or your office depending on the specific insurer you are billing. Medicare alone assigns two numbers to all providers: the unique personal identification number (UPIN), as well as a personal identification number (PIN). These numbers are only usable with Medicare claims. Further, you may have a set of completely different numbers assigned from Blue Shield, Blue Cross or another organization that are only viable for a specific insurer. This can obviously be confusing at best, especially for the uninitiated.
The use of NPIs will not be fully in place or mandated until May 23, 2007, but many carriers are attempting to avoid a last-minute rush and are requesting that you obtain the number and supply it, so they can place it in their system and be ready for the 2007 implementation. Blue Shield has been actively requesting NPIs since mid-June. Medicare is also following suit, as they are requiring all applicants for Medicare to apply and receive their NPI before completing the Medicare application.
The use of the NPI certainly will simplify how providers and insurers are identified and should essentially eliminate the mistakes that result from using several numbers - mistakes that will ultimately delay the payment of claims.
To apply for an NPI, the Centers for Medicare and Medicaid Services provide an online application, which takes approximately 20 minutes to complete, securing your NPI. It certainly is something you should do now, rather than at the last minute, to avoid any interruption of billing or payment. To access the online application, go to https://nppes.cms.hhs.gov/NPPES. If you do not have Internet access, call (800) 465-3203 for an application.
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