National Provider Identifier
What?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates the adoption of a National Provider Identifier (NPI), a standard unique identifier for health care providers and organizations that are defined as covered entities under HIPAA. Providers who transmit health information in electronic form via standard HIPAA electronic transactions are considered covered entities.
Who?
All health care providers, including dentists, are eligible for NPI’s. All HIPAA covered entities must obtain an NPI to identify themselves in HIPAA standard transactions.
Some payers are mandating that both the treating dentist and the billing entity submit an NPI. You must have an individual NPI, even if you are a solo practitioner with an incorporated practice and have received one for that entity. NDEDIC recommends that every practicing dentist obtain an individual NPI – even if you do not submit standard HIPAA electronic transactions. This is because some carriers may require an NPI, even on paper claims.
When?
The regulation requires that health care providers submit NPI’s rather than a carrier’s unique identifier on all claims submitted after May 23, 2007. However, the billing provider’s TIN (or SSN) will still be required on all claims.
Prior to May 23, 2007, most carriers will notify providers when they will be capable of accepting only the NPI number rather than their own identifiers.
How?
Requesting your NPI number is free and is as simple as applying for a Social Security Number.
There are three ways a provider can apply for an NPI:
- Complete the application online at https://nppes.cms.hhs.gov/.
- Complete a paper application by downloading it from http://www.cms.hhs.gov/cmsforms/downloads/cms10114.pdf or by calling 1-800-465-3203 to request a copy of the application.
- An organization may submit the application in an electronic file on behalf of the provider.
Refer to the linked checklist of information you will need to have handy when you apply.
Why?
Using the NPI will make doing business with a number of carriers much easier. You will need to remember and submit only one number plus your TIN (or SSN). Without an NPI you may risk having claims payments interrupted. Get your NPI number as soon as possible and begin to use once carriers have given you the go ahead.
Remember - the lack of an NPI(s) could delay claim processing and payment.
This information has been provided to help answer many of the questions related to NPI as well as ease the process of obtaining an NPI. NDEDIC shall not be held liable for the use of the information nor any damage that may be incurred as a result of the use of this information. NDEDIC has prepared this information in good faith in an effort to serve its membership and their clients.