Frequently Asked Questions

• What is "NPI"?

The National Provider Identifier is a unique 10 digit number assigned to a health care provider. It is required by HIPAA. It does not replace the TIN or DEA numbers.

• When is the mandate effective?

23-May-05

• What is the compliance date?

23-May-07

• Who must comply?

HIPAA covered entities using electronic transactions- Providers, Clearinghouses, Payers.

• Who will assign the numbers?

National Provider System will be developed under contract with HHS. Please see the Fox Systems Press Release, (Fox Systems announces selection as NPI enumerator contractor).

• When can providers start requesting NPI?

23-May-05

• Who is eligible for an NPI?

Any individual healthcare provider or organization provider except for nontraditional services that are indirectly health care-related such as taxi, home and vehicle modifications, insect control, habilitation and respite services

• How will the NPI's be assigned?

The covered health care provider will obtain the NPI and then determine any necessary NPI's for their subparts. Those providers with UPIN's already in place will most likely be cross walked to an NPI value.

• What is a subpart?

Entities that are parts of covered organizational providers. These entities may function independently of the covered organization, may have their own billing numbers, licensure and or physical location. ie. clinics, departments, pharmacies, DME suppliers and nursing homes.

• Who determines how many NPI's will be assigned to any given entity?

Each provider is responsible for determining the number of NPIs needed for their organization.

• Can payers require providers to enumerate a specific way?

No. Though the rule notes the ability of a health plan to require NPI, plans can only influence providers to enumerate in a given manner.

• How does the effective date (5/23/2005) for NPI impact Health Plans?

Plans will be able to accept an NPI from a provider on any HIPAA electronic transaction. Please contact health plans for acceptance timelines. (Contacts list provided.

• How does the compliance date (May 23, 2007) for NPI impact Health Plans?

Plans will be able to accept the NPI as the identifier for all HIPAA electronic transactions. Please contact the individual health plans with any questions.

• Are paper transactions included in the mandate?

No. Paper transactions are not considered electronic transactions.

• Does the draft NPI application seem to indicate that entities doing standard HIPAA transactions may get access to the National Provider System?

Yes.

For additional questions and NPI updates, please visit Centers for Medicare and Medicaid Services and select "HIPAA Administrative Simplification" as the Topic and select "Identifier" as the Sub-Topic.