The National Provider Identifier (NPI) is an Administrative Simplification Standard under the Health Insurance Portability and Accountability Act (HIPAA).
For covered health care facilities, the NPI is a distinctive identification number. In the administrative and financial transactions implemented under HIPAA, covered health care services and all health program and health care clearinghouses must use the NPIs.
The NPI is an intelligence-free, 10-position numerical identifier (10-digit number). This means that the statistics do not hold other information, such as the state in which they live or their medical specialty, about healthcare providers.
The NPI must be used in HIPAA standards transactions in place of legacy provider identifiers.
What is the National Provider Identifier (NPI) Requirement?
The federal Department of Health and Human Services has required the use of the National Provider Identifier due to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (NPI). The Governing Rules for NPI were established and published by CMS on January 23, 2004.
Does the Physician need an NPI?
All health care providers are eligible to receive an NPI as mandated by HIPPA. In the law, the broad definition of health care provider includes all those offering health care services: individuals, including dentists, physicians, doctors, and all other practitioners, and entities such as hospitals, pharmacies, clinics, and companies that supply medical supplies.
Do Physician NPI numbers expire?
No, physician NPI numbers do not expire. Once a physician gets an NPI, it will remain the same throughout his life. Only in rare circumstances will you be able to obtain a replacement NPI (I.e., fraudulent use).
If you work at two practice locations (i.e., a clinic and at your private practice), do you need to get two NPIs?
The answer is No. You do not need two NPI numbers. Your individual NPI follows you everywhere.
However, if you’ve reassigned your benefits to the facility, all HIPAA compliant claims made for your services will be appropriate for their community NPI. Your NPI should appear in every HIPAA transaction if you have not reassigned your benefits to the clinic.