NATIONAL PROVIDER IDENTIFIER (NPI)
News
We are passing along to you the latest information we have received about the National Provider Identifier (NPI) that many of you have been asking about.
We think everyone should consider getting an NPI even if you don't file claims electronically because we have been told that eventually this will become an industry standard. Medicare will require the NPI on its paper forms. Read on...
National Provider Identifiers (NPIs) will be required on electronic claims on and after May 23, 2007. Every health care provider who files electronically should obtain an NPI.
Time To Review Your NPI Information to Avoid Disclosure of Sensitive Data
The National Plan and Provider Enumeration System (NPPES) Data Elements may be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) under the Freedom of Information Act (FOIA). This refers to the information you provided when you applied for your NPI.
CMS believes health care providers need time in which to view their FOIS-disclosable NPPES data and make any updates, changes or deletions that they feel are necessary. Therefore, CMS has decided to delay the dissemination of this data until August 1, 2007. According to the Privacy Act certain information will not be made available to the public: Social Security Numbers (SSN), IRS Individual Taxpayer Identification Numbers (IRS ITIN) and Dates of Birth (DOB).
Health care providers should weigh privacy and security concerns when reviewing the optional data in their NPI file. It is important to note the section "Other Provider Identifier" where providers may, as an option, report their legacy identifiers that may have been assigned to providers by health plans. Providers may report some, none or all of their "Other Provider Identifiers." This data is used to assist health plans create a link between providers' NPIs and the identifiers that health plans have assigned to them. Providers are NOT to report their Social Security Numbers (SSN) or IRS Individual Taxpayer Identification Numbers (IRS ITIN) in this section.
Health care providers may revise or update their NPI data at any time; however, to avoid any disclosure of the optional data you are urged to revise your NPI by July 30th.
Providers are encouraged to use the web-based process to make their updates, changes, and deletions: http://nppes.cms.hhs.gov. This is the fastest and most efficient method. Or providers may submit updates on the CMS-10114, NPI Application /Update Form. Providers may call the Enumerator (1-800-465-3203) for a copy or may download a copy from the CMS forms page: www.cms.hhs.gov/cmsforms/. Updates, changes, and deletions may not be made by telephone, fax or email.
How Do I Share My NPI with Medicare?
Please share your NPI with Medicare by submitting it on Medicare claims. Unlike some health plans, there is no fax number, phone number or special website you need to use to communicate your NPI to Medicare. Medicare is now asking that submitters send a small number of claims using only the NPI. If no claims are rejected, the submitter can gradually increase the volume.
Importance of Up-to-Date Billing Software
Providers who use billing software should make sure they are using the most current version. Software vendors have made changes to accommodate the NPI. Running an outdated software version could contribute to claim rejections or the inability to send your NPI.
Still Confused?
Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found at the CMS NPI page www.cms.hhs.gov.NationalProvidentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or call the NPI enumerator to request a paper application at 1-800-465-3203 ; TTY 1-800-692-2326.