In six months, 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. NPIs will replace UPINs and other payor-specific provider identification numbers.

Physicians are strongly urged to apply for NPIs immediately, if they haven’t already done so. According to the Centers for Medicare & Medicaid Services, as of October only half the nation’s 2.3 million health care providers had applied for an NPI. This means there will be a backlog of applications in the final 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.

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.

CMA is also surveying major California payors to assess their NPI-readiness. The results of the survey, which was mailed to payors earlier this month, will be made available to members as soon as possible.

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 the CMA bookstore.

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