On May 24, physicians who are covered by HIPAA will be required by federal law 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 must also register their NPIs with Medi-Cal by May 23 to ensure that their payments are not interrupted when Medi-Cal transitions from its current provider numbering system to the NPI system. To ease the transition, Medi-Cal will offer a “dual use” period, during which physicians will be encouraged to use both their Medi-Cal provider numbers and their NPIs (if available) on Medi-Cal claim forms. During this transition period, NPI use is encouraged but not required for adjudication. This “dual use” period applies only to Medi-Cal. On May 24, claims submitted to Medicare and private payors will be denied if submitted without an NPI.

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’s legal department has also written a primer to help physicians with the NPI process. The primer, available through the CMA ON-CALL system, is available free to members at the members-only website. See document #1608, “National Provider Identifiers.” 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.