National Provider Identifier (NPI) Final Rule – HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services (HHS) adopt a standard unique health identifier for health care providers. On January 23, 2004, HHS published the Final Rule that adopts the National Provider Identifier (the NPI) as the standard unique health identifier for health care providers. The effective date of the ruling is May 23, 2005. The compliance date for all covered entities is May 23, 2007.

When the NPI is implemented, covered entities will use the NPI as their primary identification number to identify health care providers in all standard electronic transactions. Once compliance is mandated by the Final Rule legacy identification numbers (e.g. UPIN, Blue Cross and Blue Shield of Alabama provider numbers, Medicare and Medicaid providers numbers, etc) will not be permitted. Health care providers will no longer have different numbers to identify themselves to one or more health plans.

The National Provider System (NPS) being built under the Centers for Medicare and Medicaid Services (CMS) contract will process applications and updates, ensure the uniqueness of the health care providers, and generate the NPI’s.

As with other aspects of HIPAA, this Final Rule will add simplification but will also significantly affect many of the aspects of how you conduct electronic transactions with all health insurers. Information about NPI implementation, including information on how to apply for NPI’s will be made available by CMS to the health care industry as we move closer to the effective date.

CMS Frequently Asked Questions about NPI

National Provider Identifier Glossary

NPI Overview - Power Point Presentation

NPI Payroll Scenarios

NPI Publication - NPI Countdown

CMS Determination of Subparts

NPI Form

Apply For A NPI

Starting May 23, 2005, all health care providers may begin to apply for their National Provider Identifier (NPI). For additional information, and to complete an application, visit https://nppes.cms.hhs.gov on the web.

Also, an instructional web tool, called the NPI Viewlet, is now available for viewing at http://www.cms.hhs.gov/medlearn/npi/npiviewlet.asp and under "HIPAA Latest News" at www.cms.hhs.gov/hipaa/hipaa2 on the CMS website. This tool provides an overview of the NPI, a walk through of the application, as well as live links to the NPPES website where the providers may apply for an NPI.

Blue Cross and Blue Shield of Alabama has been working through its processes to be determine how to implement the use of the NPI. We will be providing updates and information as the implementation plans and processes are developed. It is important that you as providers understand this new ruling and how it will impact you as well as the other insurers that you do business with.

You may access information about NPI through the following links:

• http://aspe.hhs.gov/admnsimp/index.shtml
  HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule
• http://www.cms.hhs.gov/hipaa/hipaa2/
  CMS - Health Insurance Portability and Accountability Act (HIPAA) - Administrative Simplification
• http://www.cms.hhs.gov/NationalProvIdentStand/- Although the NPI information and educational materials on this web page have been developed for Medicare FFS providers, these resources may be useful to other health care providers.