The Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the adoption of a standard unique identifier for health care providers. The NPI final rule issued January 23, 2004 adopted the NPI as this standard.
The NPI is a 10-digit, intelligence free numeric identifier (10 digit number). Intelligence free means that the numbers do not carry information about health care providers, such as the state in which they practice or their provider type or specialization. The NPI will replace health care provider identifiers in use today in HIPAA standard transactions. Those numbers include Medicare legacy ID’s (UPIN, OSCAR, PIN, and National Supplier Clearinghouse or NSC). The provider’s NPI will not change and will remain with the provider regardless of job or location changes.
All health care providers (e.g., physicians, suppliers, hospitals, and others) are eligible for NPIs. Health care providers are individuals or organizations that render health care. All health care providers who are HIPAA-covered entities, whether they are individuals (such as physicians, nurses, dentist, chiropractors, physical therapists, or pharmacists) or organizations (such as a hospitals, home health agencies, clinics, nursing homes, residential centers, laboratories, ambulance companies, group practices, HMOs, suppliers of durable medical equipment, pharmacies, etc.), must obtain an NPI to identify themselves in HIPAA standard transactions.
HIPAA covered entities such as health care providers who conduct HIPAA standard transactions, healthcare clearing houses, and all but small health plans, must use only the NPI to identify HIPAA covered health care providers in standard transaction by May 23, 2007.
Medicare Fee-For-Service (FFS) providers can begin to use the NPI January 3, 2006. Medicare systems will accept claims with an NPI, but an existing Medicare legacy identifier must also be on the claim. Starting October 2, 2006, Medicare FFS providers may submit an existing Medicare legacy identifier and/or an NPI on claims.
As the NPI replaces the unique physician identification number (UPIN), as well on other previously assigned provider numbers by payers and other entities, it is imperative that you share your NPI number with Clinical Laboratory Partners as soon as you obtain one. Your NPI number identifies you as the ordering provider.
The following CMS web site provides detailed information and will assist you in applying for and obtaining your NPI number: www.cms.hhs.gov/nationalprovidentstand/03_apply.asp#