National Provider Identifier—Are You Ready?
[Posted 01/26/06]

Next year, physicians will no longer have to keep track of and use multiple identification numbers assigned to them by health plans. Effective May 23, 2007, physicians will instead use a single “national provider identifier” (NPI).

The HIPAA-mandated national provider identification system promises to simplify electronic health care transactions and create a more easily accessible database of provider information for credentialing and contracting purposes.

In theory, obtaining an NPI should be simple. But we are learning in real life it may be more complicated.

For example, physicians may unknowingly have an NPI application submitted on their behalf by an organization (such as a medical group, IPA, or hospital). Duplicate applications could delay processing. (The law requires anyone applying on your behalf to notify you that they are doing so. You may, however, want to check with any groups you are affiliated with to be sure that they have not done so.) Physicians are encouraged to submit their own applications and safeguard their NPIs to ensure that they are not used improperly or fraudulently.

NPIs will also pose a unique challenge to your software systems, including billing and electronic health records. Will your software systems be current with the new number when it is required? Physicians are advised to start an inventory as soon as it is practical.

Physicians are also encouraged to submit NPI applications as early as possible so that they will be ready when health plans begin to accept the national identifiers. It is likely that some plans will begin using NPIs prior to May 23, 2007.

Physicians can apply online at http://nppes.cms.hhs.gov. A downloadable application form is also available that can be printed and submitted by mail.

More information on NPIs is available in CMA ON-CALL document #1608, “National Provider Identification Numbers.” ON-CALL documents are free to members at CMA's members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in CMA's online bookstore.

CMA’s HIPAA partner, PrivaPlan Associates Inc., will soon release an inexpensive CD-ROM toolkit to help physicians navigate the NPI process. Details will be published in CMA Alert when the toolkit is available.

Contact: CMA's legal information line, 415/882-5144 or legalinfo@cmanet.org.