National Provider Identifier Type 1Workforce Training
Month Day, Year
The NPI will become the standard, unique identifier for health care providers in HIPAA Transactions
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Purpose
• This training presentation is being delivered to educate workforce members on– National Provider Identifier Requirement
– How to Obtain an NPI
– How to Report NPI to Facility/Division
– NPI Resources Available
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Background
• The NPI is a HIPAA Administrative Simplification Standard– Transactions and Code Sets
– Security
– Privacy
– Identifiers• Unique Employer Identifier• Unique Health Care Provider Identifier (NPI) • Unique Health Plan Identifier – Proposed rule
pending
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• Published January 23, 2004• Requires the use of the NPI in standard
transactions to identify health care providers standard transactions no later than 5/23/07
• Replaces the use of proprietary and legacy provider identifiers in standard transactions
– Unique Physician Identification Number (UPIN)
– Medicaid ID
– Medicare ID
– BCBS, Aetna, etc. IDs
NPI Final Rule
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• Placed requirements on HIPAA covered entities
– Health plans (e.g., Medicare, NC Medicaid, BCBS)
– Health care clearinghouses
– Health care providers conducting HIPAA standard transactions • DMH/DD/SAS facilities• DPH State Lab and CDSAs• OES Schools
NPI Final Rule – cont’d
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• All health care providers who conduct any of the HIPAA standard transactions– Individuals – NPI Type 1
• These individuals furnish health care services that are billed using HIPAA standard electronic transactions or may initiate and / or receive referrals. This includes: – DHHS Workforce Members– Private Providers
– Organizations – NPI Type 2– Organization “Subparts” – NPI Type 2
• Components of organizations that conduct transactions separately from the rest of the organization
• Note – all “health care providers” as defined by 160.103 are eligible for NPI
Who Must Get an NPI?
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• List Provider Types Here
Who Must Get an NPI in This Facility?
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What is an NPI?
• 10 digit number• All numeric• Never changes
– Good for the life of the provider– May be deactivated/reactivated
• Does not itself convey information about the provider– Legacy provider numbers may have
“intelligence” that describes the provider type, specialty, and location
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Who Assigns NPIs?
• NPI Enumerator – HHS contracted with Fox Systems, Inc.– Process applications and assigns NPIs
– Maintains NPI data in the National Plan and Provider Enumeration System (NPPES)
– Furnishes NPI information upon request and in accordance with established guidelines• Privacy Policy available at
https://nppes.cms.hhs.gov/
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DHHS Approach to Workforce Enumeration
• DHHS HIPAA Oversight Committee Recommendation– DHHS not assume the responsibility to
submit NPI applications for workforce members
– Memo sent to DHHS Division Directors April 2006 (http://hipaa.dhhs.state.nc.us/hipaa2002/identifiers/identifiers.html)
• DHHS Policy under development to support decision
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Requirements for DHHS Workforce
• DHHS workforce members must– Apply for NPI by schedule required by
facility/division
– Report NPI data to facility/division NPI Contact
– Maintain data supplied to obtain NPI changes• Updates to be made within 30 days of change
– Report appropriate changes to facility/division NPI Contact
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Before You Apply• Collect the following information
– SSN or Individual Taxpayer Identification Number
– Date of Birth
– Country of Birth
– State of Birth (if Country of Birth is U.S.)
– Gender
– Mailing Address
– Practice Location Address and Phone Number
– Taxonomy Code(s)
– State License or Certification Information (required for certain Taxonomy Codes)
– Contact Phone Number and Email Address
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Taxonomy Codes Explained
• An additional, unique, 10 position number to be listed on NPI application – Minimum of one required; up to 14 allowable– Some require license/certification number
• Provides additional information on provider (replaces missing legacy ID “intelligence”)– Provider Type– Classification– Area of Specialization
• Situational use on transactions – requirement TBD by each health plan – DHHS assuming all plans will require
• Taxonomy Code list available atwww.wpc-edi.com/taxonomy– Use “Individual or Groups (of Individuals)” list
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How to Apply• Two options available at
https://nppes.cms.hhs.gov/– Paper Form
• Make a copy before mailing
• Keep notification letter of assigned NPI
– Electronic Form – Recommended • Self-assigned ID and Password – store in safe place
• Print every page before advancing
• Keep notification email of assigned NPI
• Helpful HINT: Review CMS NPI Viewlet before applying!– http://www.cms.hhs.gov/apps/npi/npiviewlet.asp
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What to Report
• Provide a copy of the NPI assignment letter/email
• Include Taxonomy Code(s) listed on application
• Give to NPI Contact designated by your Facility or Division
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Your NPI Contacts Are
• Name– Phone
– Email Address
– MSC Code
• Name– Phone
– Email Address
– MSC Code
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Reporting Schedule
• Facility/Division Schedule to be inserted here
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NPI Resources
• Centers for Medicare and Medicaid Services (CMS)– http://www.cms.hhs.gov/apps/npi/
01_overview.asp
• DHHS HIPAA Web Site– http://hipaa.dhhs.state.nc.us/hipaa2002/
identifiers/identifiers.html
– Contains Helpful Hints, FAQs, and other useful information
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NPI Resources – cont’d
• NPI Enumerator– https://nppes.cms.hhs.gov/
– 1-800-465-3203 or TTY 1-800-692-2326
– Can provide copies of NPI notification letter if lost