FAQ: National Provider Identifier (NPI)
IMPORTANT NOTE: All claims electronically submitted without a National Provider Identifier (NPI) will be rejected beginning May 23, 2008.
Q: What is NPI?
A: The National Provider Identifier (NPI) is a 10-digit identifier
required on all HIPAA-standard electronic transactions. NPIs have
replaced all separately issued identifiers, including Medicaid PINs
and Medicare UPINs, on HIPAA-standard electronic transactions. In
the past, health plans assigned an identifying number to each
provider with whom they conducted electronic business. Since
providers typically work with several health plans, they were
likely to have a different identification number for each plan. The
NPI has been put in place so that each provider has one unique,
government-issued identifier to be used in transactions with all
health plans with which the provider conducts business.
Q: Is the NPI required for all health care
providers?
A: Yes, NIA expects all providers submitting claims electronically
to obtain and use an NPI. The NPI is required for all health care
providers covered under HIPAA, including but not limited to NIA
facilities and individual practitioners.
Q: Does my NPI replace my Taxpayer Identification Number
(TIN)?
A: No, your NPI does not replace your TIN. TINs continue to be
required on all claims - paper and electronic. The NPI is for
identification purposes, while the TIN is for tax purposes.
Important - claims that do not include a TIN will be
rejected.
Q: How do I find out more about the NPI?
A: You can find more about the NPI by visiting the Centers for Medicare & Medicaid Services (CMS)
Web site. This site includes the NPI Final Rule and an
announcement letter to providers.
NIA-Specific NPI Information
Q: As of May 23, 2008, does NIA require NPIs on all
HIPAA standard electronic transactions?
A: Yes. While NIA fully expected providers to meet the original May
23, 2007 compliance date, we have been temporarily allowing
HIPAA-standard electronic transactions to be submitted without
NPIs. But, effective May 23, 2008, we require the NPI on those
electronic transactions.
Q: Where can I find more information about CMS guidance
on compliance with the HIPAA NPI Rule?
A: To view frequently asked questions about CMS Contingency
Guidance:
- Go to the CMS Web page at www.cms.hhs.gov/NationalProvIdentStand.
- Scroll down to the section that says "Related Links Inside CMS."
- Click on "NPI Frequently Asked Questions (FAQs)."
Applying for NPIs and Submitting NPIs
Q: How do I apply for my NPI?
A: If you have not yet applied for an NPI, you should do so as soon
as possible in one of three ways:
- For the most efficient application processing and the fastest receipt of an NPI, use the Web-based NPI application process. Log on to the National Plan and Provider Enumeration System (NPPES) and apply online at https://nppes.cms.hhs.gov/NPPES/Welcome.do.
- You can agree to have an Electronic File Interchange (EFI) organization (EFIO) submit application data on your behalf (i.e., through a bulk enumeration process) if an EFIO requests your permission to do so.
- You may wish to obtain a copy of the paper NPI
Application/Update Form (CMS-10114) by contacting the
Enumerator:
By phone: 1-800-465-3203 or TTY 1-800-692-2326
By e-mail: customerservice@npienumerator.com
By mail:
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059 - Please see the CMS Web site for "Tips to Expedite your NPI Application."
Q: How do I submit my NPI to NIA?
A: You can also submit your NPI by mail or fax by sending us a copy
of your NPI notification letter or the e-mail from NPPES:
National Imaging Associates
Attn: Data Management
14100 Magellan Plaza
Maryland Heights, MO 63043
Fax number: 314-387-5584
Q: What if I no longer have a copy of my NPI
notification letter or e-mail?
A: You can log in to the NPI
Enumerator page and print a copy of your NPI notification
e-mail from NPPES, or you can contact the NPI Enumerator to request
a copy of your NPI notification letter or e-mail.
By phone: 1-800-465-3203 or TTY 1-800-692-2326
By e-mail: customerservice@npienumerator.com
By mail:
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059
Q: If an Electronic File Interchange (EFI) organization
obtained my NPI for me, how do I obtain a copy of the NPI
notification?
A: You should contact the EFI organization that obtained the NPI
for you.
Q: Is NIA now accepting the NPI on HIPAA-standard
electronic transactions?
A: Yes, NIA has been accepting NPIs on HIPAA-standard electronic
transactions since October 2006.
Q: Is NIA accepting NPIs on paper claim forms (CMS-1500
and UB-04 forms)?
A: Yes, NIA accepts NPIs on both the CMS-1500 (version 08/05) and
the UB-04 forms. If you submit on paper claims, we encourage you to
submit your NPI on paper claims.
Q: Where are the main NPI (Type 2) and rendering NPIs
(Type 1) to be inserted on electronic transactions and on the paper
claims forms?
A:
- For claims submitted via the ASC X12N 837 professional health care claim transaction, place the Type 2 NPI in the provider billing segment, loop 2010AA; and the Type 1 NPI in loop 2310B.
- On the CMS-1500 form (version 08/05), insert the main or billing Type 2 NPI number in Box 33a. Insert the service facility Type 2 NPI (if different from main or billing NPI) in Box 32a. Insert Type 1 NPIs for rendering providers in Box 24J.
- On the UB-04 form, insert the main Type 2 NPI number in Box 56; insert Type 1 NPIs for rendering providers in boxes 76 - 79.
Q: What is a Type 1 NPI and Type 2 NPI?
A:
Type 1 - Health care providers who are individuals, including
physicians, radiologists and all sole proprietors. An individual is
eligible for only one NPI.
Type 2 - Health care providers that are organizations, including
physician groups, hospitals, nursing homes, and the corporations
formed when an individual incorporates him/herself.
Organization and Subpart Information
Q: I am with an organization. Do the individual
practitioners with my organization need to apply for individual
(Type 1) NPIs?
A: Individual providers with organizations are not
required to apply for individual (Type 1) NPIs or submit Type
1 NPIs.
Q: What is a subpart and why is a subpart enumeration
necessary?
A: Health care organizations may be comprised of components that
function as health care providers somewhat independently of the
"parent." Subparts are the components that might conduct their own
HIPAA-standard transactions, might be certified by the State
separately from their "parent," or might be situated at the same
location as, or a different location from, their "parent."
Subpart determination ensures that those entities/components are identified in HIPAA-standard transactions by their unique NPIs.
Q: How can an organization choose to
enumerate?
A. Organizations can choose to enumerate subparts by
taxonomy/specialty, TIN or site address.
Q: Does NIA prefer that organizations enumerate a
certain way?
A: In order to facilitate a smoother administration in our provider
and claims systems for providers/facilities that submit, or plan to
submit, electronic claims:
- If you are a facility with a single-site address and multiple TINs, we prefer that you enumerate subparts at the TIN level.
- If you are a facility with multiple site addresses, we prefer that you enumerate subparts at the site address level.
Q: Where do I find more information about
subparts?
A:
- For more information on how to enumerate subparts, please visit Medicare's Subpart Expectations Paper (PDF).
- Also, you can read an NPI Fact Sheet titled
"Guidance on Subpart Determination for Medicare Organization
Providers Who Are Covered Entities Under HIPAA." (PDF)