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Only 153 more days until the National Provider

Identifier (NPI) compliance date!

If you are a health care provider who bills for services, you probably need an NPI. Do you have your NPI?

By Marcia Pryce, MPH, CHES Centers for Medicare & Medicaid Services (CMS) Division of Medicare Operations (DMO)

Health care providers include individuals, such as physicians, dentist, and pharmacists, and organizations, such as hospitals, nursing homes, pharmacists, and group practices.

Health care providers who transmit health information electronically in connection with any of the standard transactions are required by NPI Final Rule to obtain NPIs, even if they use business associates, such as billing agencies, to prepare transactions.

The NPI will replace health care provider identifiers that are in use today in standard transactions. Implementation of the NPI will eliminate the need for health care providers to use different identification numbers to identify themselves when conducting standard Medicaid, and private health insurances issuers, and all health clearinghouses must accept and use NPIs in standard transactions by May 23,2007.Small health plans have until May 23,2008. After those compliance dates, health care providers may use only their NPIs to identify themselves in standard transactions, where the NPI is called for.

When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI.

Get It. Share It. Use It.

If you are a health care provider who bills for services, you probably need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy. Getting an NPI is free. The first step is to get your NPI. Once you obtain your NPI, it is estimated that it will take 120 days to do the remaining work to use it. This includes working on your internal billing systems, coordinating with billing services, vendors, and clearinghouses, testing with payers. As outlined in the Federal Regulation, (The Health Insurance Portability and Accountability Act of 1996 (HIPAA)) you must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. If you delay applying for your NPI, you risk your cash flow and that of your health care partners as well.

Getting an NPI is free - Not Having One Can Be Costly.

Still Confused?
Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found at the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.



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