New National Provider Identification Numbers Available

CMS recently announced the availability of a new National Provider Identifier (NPI) for use in standard electronic transactions as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NPI must be used by most HIPAA covered entities, including health care providers, health plans, and health clearinghouses. The NPI will replace the health care provider identifiers currently in use. 

Health plans, including Medicare, Medicaid, and private insurers, must accept and use NPIs in standard electronic transactions by May 23, 2007. Small health plans have until May 23, 2008, to comply. By these deadlines, all health care providers must use only their NPIs as identifiers in standard electronic transactions. Standard electronic transactions include claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance advices.

Providers may apply for an NPI online at https://nppes.cms.hhs.gov. Effective July 1, 2005, paper applications are being accepted and are available on the Web site or by contacting the National Plan and Provider Enumeration System (NPPES) at (800) 465-3203. Providers need to apply for only one NPI that will be used by all health plans. Health care providers are urged to apply for an NPI early. However, Medicare, as well as other health plans, is not yet accepting the NPI in standard electronic transactions. Additional information about when health plans will begin implementing and accepting the NPI will be made available in the coming months.