Don’t Wait Until the Last Minute to Get Your National Provider ID
[Posted 06/08/06]

In less than a year, physicians who are covered by HIPAA will be required to use their new National Provider Identifier (NPI) on claims and other electronic health care transactions. All Physicians who bill Medicare—even if not covered by HIPAA—must also obtain and begin using NPIs by the May 2007 deadline. NPIs will replace UPINs and other payer-specific provider identification numbers.

Beginning May 24, 2007, Medicare providers and physicians covered by HIPAA will have their claims denied if they do not have NPIs. This is not an idle threat. Physicians will have had two full years to get their NPIs.

Physicians are strongly urged to apply for NPIs immediately, if they haven’t already done so. Because many health care providers are expected to wait until the last minute to apply for their NPIs, there will likely be a backlog of applications in months leading up to the deadline. To make sure you get your NPI on time, you should submit your application as soon as possible.

Applying for an NPI is fairly simple. Physicians can apply online at https://nppes.cms.hhs.gov. If you do not have Internet access, call the NPI Enumerator at 800/465-3203 and request a paper application form. (Physicians groups and incorporated physician practices of all sizes will likely need to apply for more than one NPI. More information is available in CMA’s NPI toolkit. See details below.)

While applying for an NPI is straightforward, making sure your billing systems and vendors are ready for the transition is a more complicated process, one that requires some preparation and internal assessment. CMA’s HIPAA partner, PrivaPlan, has developed an inexpensive CD-ROM toolkit to help physicians navigate the process.

If you haven’t investigated it, you should give it a look. The toolkit will help physicians understand their NPI “readiness” and the impact the NPI may have on their practices. It also provides form letters and surveys to send to your major system vendors, clearinghouses, and health plans, to determine their NPI readiness.

CMA members can purchase the toolkit for $99. CMA members who have purchased PrivaPlan’s other HIPAA toolkits pay $79. Nonmembers pay $129. Order the toolkit by calling 877/218-7707.

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.

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