National Provider Identifiers: What You Need to Know

A National Provider Identifier (NPI) is a specific identification number for covered health care providers issued by the Centers for Medicare and Medicaid Services (CMS). The purpose of the NPI system is to improve efficiency of the electronic transmission of health information and all covered health care plans and providers are required to use their NPIs for administrative and financial transactions.

Facts about NPIs that you should know:

• An NPI is mandatory for payer enrollment—your Medicare enrollment application will be turned down without an NPI. Any provider covered under HIPAA must obtain and NPI.

• Your NPI will uniquely identify you as a health care provider for transactions such as claims, inpatient medical record systems, prescriptions and coordination of benefits.

• An NPI is a 10-digit intelligence-free identifier. What this means is that the numbers are assigned randomly and do not contain any other information about a health care provider such as medical specialty, location, etc.

• You are required to give your NPI to other entities that may need it for billing transactions. These entities include health plans, other providers and clearinghouses.

• Apply for an NPI online here or you can request a paper application by calling 800-465-3203 which you can then fill out and mail in.

• If you move, you must notify NPPES of a change of address within 30 days of the effective date of the change. Address changes may be submitted online here.

To learn more about NPIs and their requirements, read 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, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.