The deadline for the implementation of National Provider Identifier (NPI) numbers by the Centers for Medicare and Medicaid Services (CMS) is May 23. For claims with dates of service of May 23, only the NPI will be accepted. For the transition period from now through May 22, Medicare recommends that health care providers submit claims with both their NPI and legacy provider numbers. However, Medicare will accept claims having only NPI as well as those having only legacy provider numbers during this period. NPIs can be submitted on CMS-1500 forms when the revised CMS-1500 begins to be accepted by Medicare on Jan. 2. Health care providers have until May 23 before they are required to submit claims with only an NPI.
If a health care provider is notified that their claim was unprocessable because a properly matching legacy number could not be found to match their NPI, he or she should resubmit the claim with the appropriate legacy number. The same means of submission should be used to refile the claim.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. On Jan. 23, 2004, the Secretary published a final rule that adopted the NPI as this identifier. All HIPAA covered health care providers, whether they are individuals or organizations, must obtain an NPI for use to identify themselves in HIPAA standard transactions. A provider’s NPI will not change and the NPI remains with the health care provider regardless of job or location changes.
HIPAA-covered entities, such as providers completing electronic transactions, health care clearinghouses, and large health plans, must use only the NPI to identify covered health care providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008.
Getting a NPI is free and providers do not need to pay an outside source to get one. Health care providers can apply for an NPI at the Web site https://nppes.cms.hhs.gov or call (800) 465-3203 to request a paper application.
