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Learn More about NPIs with these 7 Frequently-Asked Questions

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If you are a healthcare provider covered under HIPAA, or if you file claims or use a clearinghouse to bill insurance, then you are required to apply for a National Provider Identifier (NPI). This unique, 10-digit identification number is issued by the Centers for Medicare and Medicaid Services (CMS). Other healthcare providers that are not required to apply for an NPI may do so if they desire.

The NPI system was created to improve the electronic transmission of health information by making it more efficient and effective. Covered healthcare providers and plans are required to use NPIs in their administrative and financial transactions.

Frequently-Asked Questions about NPIs

  1. How are NPIs assigned? Is there any logic to the assignments? NPIs are entirely random and don’t have any pattern or logic, such as a medical specialty or geographic region.

  2. How do I apply for an NPI? Apply online at this website or call 800-465-3203 to request a paper application.

  3. NPIs are mandatory for which healthcare providers? Those covered under HIPAA must use an NPI in HIPAA transactions.

  4. What are NPIs used for? As NPIs uniquely identify healthcare providers such as physicians, hospitals and suppliers, they are used in transactions including claims, prescriptions, inpatient medical record systems and coordination of benefits.

  5. Is an NPI required to enroll in Medicare? A Medicare provider enrollment application without an NPI will be rejected.

  6. Are there benefits to having an NPI? Yes, benefits include the ability to perform simple electronic transmission of HIPAA standard transactions, having standard and unique health identifiers for healthcare providers, plans and employers, and efficient coordination of benefit transactions.

  7. Once I supply personal information like address and telephone number, must it be available in the NPI database? The database draws information from NPI applications, but you can request that NPI data be removed. However, NPI lookup service must be available with your city and state of practice, specialty and credentials linked to your NPI number.

You can learn more in the CMS online publication NPI: What You Need To Know.

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If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, Vice President of Credentialing, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.

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