To prevent health care fraud and ensure quality care, the Centers for Medicare & Medicaid (CMS) introduced the NPI number. Validates the credentials of the provider or health professional who cares for patients, prescribes medications, or requests supplies and equipment.
As a healthcare provider, you’ve probably heard of NPI numbers. But still wondering if you need an NPI or not? Is it really important to get one?
The answer is yes.’ You need an NPI ASAP!
If you do not clearly understand the NPI and how to apply for your NPI number, you no longer have to worry. We’ve got you covered.
This guide provides all the important information you will need about NPI, its requirements, and registration, including NPI search and related details.
NPI stands for National Provider Identifier. It is a special 10-digit numerical identifier assigned to health professionals and organizations.
The NPI was established as the Administrative Simplification Standard in 2004 and therefore became a legal requirement under the Health Insurance Portability and Accountability Act (HIPAA).
The Centers for Medicare & Medicaid (CMS) assigns the National Provider Identifier (NPI) number to health care providers through the National Provider and Plan Enumeration System (NPPES) registry.
What is the purpose of the NPI number?
All individuals and organizations that meet the criteria for health care providers working under HIPAA can obtain your unique NPI number. This will remain with the healthcare professionals for as long as they practice under the law.
Even if the location, roles, and duties of health professionals change, the NPI number remains the same. As an unintelligent numerical identifier, NPI does not contain any information about healthcare providers.
This number was entered for billing and administrative purposes only. The NPI must be used for all standard HIPAA electronic transactions. It offers a more convenient way to complete prescription forms, claim forms, status inquiries, transactions with health care plans, medical records that identify patients’ previous health care providers, and general HIPAA correspondence.
Therefore, the National Provider Identifier (NPI) number helps improve the effectiveness and efficiency of the electronic transmission of health information by preventing fraud.
NPI vs. UPIN
Before the National Provider Identifier (NPI) number, the Centers for Medicare & Medicaid Services (CMS) used the Unique Physician Identification Number (UPIN) to recognize doctors and non-medical professionals.
UPIN was a 6 character alphanumeric identifier. But it was discontinued in 2007. Now, NPI has replaced UPIN. NPI ensures quality services and prevents fraud more effectively as the new provider identification number.
However, it is important to note that an NPI number does not necessarily guarantee that the health professional is fully licensed.
Also, remember that the National Provider Identifier (NPI) number only replaces the identification numbers used by health care providers under HIPAA. All other identification numbers, such as Social Security Number, license number, as well as Taxpayer Identification Number (TIM) and/or Drug Enforcement Administration registration, cannot be substituted for the NPI number.
Am I eligible for an NPI number?
Any individual or organization that meets the criteria for a healthcare provider in 45 CFR 160.103 is qualified for the National Provider Identifier (NPI) number. Therefore, if you are a healthcare provider providing healthcare services and submitting HIPAA transactions, you can obtain your NPI number through the NPPES registry.
All persons and organizations under HIPAA and related to CMS must have an NPI number. You may not submit any information electronically or conduct any transactions and communications without an NPI number. Additionally, claims filed without NPI numbers are mostly denied.
The following are some examples of people who need an NPI number:
- doctors
- dentists
- orthodontists
- nurse practitioner
- midwives
- pharmacists
- chiropractors
- occupational therapists
- counselors
Some of the organizations eligible for NPI numbers include:
- hospitals
- residential care centers
- medical equipment suppliers
- laboratories
- nursing homes
- Pharmacy
Types of NPI Providers
There are two types of National Provider Identifier (NPI) providers: Type 1 NPI providers and Type 2 NPI providers. These providers are explained below:
Type 1 NPI providers include individual health care providers. A provider under this category is assigned only one NPI number. Type 1 NPI providers are persons, including dentists, physicians, and all sole proprietors, who provide health care services as a single entity.
Anyone working as a sole proprietor will be assigned a unique NPI number. If you are in the Type 1 NPI Provider category, it means you will not obtain your employees’ NPI numbers, if applicable.
Type 2 NPI providers include organizational providers. The term organizational provider encompasses organizations such as hospitals and nursing homes, and individuals who have formed corporations.
Therefore, Type 2 NPI Numbers are assigned to incorporated professionals. In this category, incorporated individuals/organizations can also obtain NPI numbers for their employees. So instead of one NPI number, organizations get multiple NPI numbers.
Organizations greatly benefit from Type 2 NPI Numbers, as there are various departments within organizations. These departments are also known as ‘subparts’. But remember that subparts refer to those departments within the health care organization that offer different services from each other.
When each subpart has been assigned a unique NPI number, you can conveniently perform HIPAA transactions, billing, and more.
Also, incorporated professionals get one NPI number for themselves and another for their corporation.
How do I apply for an NPI?
CMS assigns NPI numbers through the NPPES registry. But before you apply for the NPI number, you need to decide if you are an NPI Type 1 provider or an NPI Type 2 provider. If you are an NPI Type 2 provider, be sure to apply on behalf of your subparts.
The subparts may also apply on their own, but the subparts are required to function in accordance with the NPI final rule.
Once you have identified your NPI provider category, you can request your NPI number.
Whether you are an individual or an organization, you can obtain the NPI number in the following three ways:
- The first option is to visit the NPPES website and obtain your NPI number through the web-based application process. First of all, you will have to create your account. Using your username and password, you can log into NPPES and within 10 minutes, you will be assigned a unique NPI number.
- The second option is to visit the CMS website and download the paper form. After that, you will need to print the form, fill it out, and then mail it to the address on the form. Or you can also send the form by email. Once your mail or email is received by CMS, your NPI number will be assigned to you.
- The third option is to have the Electronic Files Exchange Organization (EFIO) request your NPI number. This organization will provide your NPI number through a mass process.
The search for NPI
Once your NPI number is assigned to you, it will be stored in the NPPES registry. Any patient can look up her NPI in the NPI lookup database by entering her first/last name, state, or organization name. The accuracy of the search results depends on the amount of information the patient has added.
The NPI search provides the following search results:
- NPI Number: The NPI lookup provides the unique 10-digit National Provider Identification (NPI) number that is assigned to the health care provider.
- NPI Provider Type – As mentioned above, there are two types of NPI numbers. The NPI lookup also lists whether the provider is an NPI type 1 provider (individual provider) or an NPI type 2 provider (organizational provider).
- Enumeration Date: The date the provider was assigned the NPI number is called the enumeration date. It also appears in the database.
- Status: The term status represents whether the provider’s NPI is active or deactivated.
- Address: The primary address, secondary address, and/or mailing address of the provider is also listed in the NPI search results.
- Taxonomy: The healthcare provider can select one or more taxonomy codes that classify their specialization, type, or classification. However, at least one code must be chosen as the main taxonomy. The NPI search results will return the provider’s taxonomy, along with their license number and state code.
- Other Identifiers: The provider’s NPI is also checked against your Medicare and Medicaid insurers.
- Endpoint Information: Endpoint information may include provider affiliation and other related information. It also provides information on how the patient can contact the health care provider.
Conclusion
If you are providing health care services under HIPAA, you must have your unique National Provider Identifier (NPI) number. The NPI will verify your credentials as a health care provider and ensure quality care for patients. This also protects patients and prevents healthcare fraud. The process of obtaining the NPI is quite simple. So make sure you get your NPI number as soon as possible! When you have an NPI number, your patients can search for your name or the name of your organization in the NPI search database and decide whether or not you are the right provider for them.
Categories: Technology
Source: SCHOOL TRANG DAI
