n ational p rovider i dentifier type 1 workforce training month day, year the npi will become the...

National Provider Identifier Type 1Workforce Training

Month Day, Year

The NPI will become the standard, unique identifier for health care providers in HIPAA Transactions

DHHS/DIRM Projects Office - NPI Initiative 2

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


National Provider Identifier

Requirement


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


• 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


• 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


• 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?


• List Provider Types Here

Who Must Get an NPI in This Facility?


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


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/


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


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


How to Obtain an NPI


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


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


Taxonomy Codes – cont’d


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


How to Report NPI Data to Facility/Division


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


Your NPI Contacts Are

• Name– Phone

– Email Address

– MSC Code

• Name– Phone

– Email Address

– MSC Code


Reporting Schedule

• Facility/Division Schedule to be inserted here


NPI Resources Available


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


NPI Resources – cont’d

• NPI Enumerator– https://nppes.cms.hhs.gov/

– [email protected]

– 1-800-465-3203 or TTY 1-800-692-2326

– Can provide copies of NPI notification letter if lost

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