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National Provider Identifier

Newsletter

Every health care provider requires an NPI !!

The Administration Simplification segment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates the usage of a unique identifier for health care providers and health plans.

           Purpose

           To make electronic transmission of health information more efficient and

           effective, through standardizations.

           Compliance Dates

           May 23, 2007   A covered health care provider must comply with the

                                       implementation specifications no later than this date.

           May 23, 2007   A health plan that is not a small health plan.

           May 23, 2008   A small health plan.

           May 23, 2007   Health care clearinghouses.

         Application Process

           There are three ways to apply for the NPI:

§         Apply online by visiting: the official National Plan and Provider Enumeration System website.

§        Request the paper application and mail to the NPI Enumerator.

§         Submitting the application through an Electronic File Interchange (EFI) after receiving approval from the provider.

           For more information on the NPI, please view this Federal Register.   

Medicare Provider Enrollment Applications

Date: 6/5/2006                           

As of June 5, 2006, the NPI is required on all Centers for Medicare and Medicaid Services Provider Enrollment Forms. Prior to processing any provider enrollment applications (adds/changes/updates), a document validating the NPI will be required.

Recommendations by CMS

Date: 5/30/2006

Beginning October 2, 2006 and continuing through May 22, 2007, Medicare will accept the NPI or the Medicare legacy provider number on the claims it receives from providers. If there is any issue with the Provider's NPI and no Medicare provider number is included on the claim, the provider might not be paid. Therefore, Medicare strongly recommends that providers, clearinghouses, and billing services continue to submit the Medicare provider number as the secondary identifier until May 22, 2007.

Published by Wisconsin Physician's Service.