The NPI is a unique identification number for covered health care providers. It is a 10-digit numeric identifier. Under the HIPAA act, in standard transactions, covered entities must use NPI numbers.
Even health insurance providers and all health plans and health care clearinghouses must use the NPI in their standard transactions. The purpose of NPI is to improve the efficiency and effectiveness of electronic transmission of health information.
What is the purpose of NPI?
There are many benefits of NPI, and these are:-
- It allows health insurance providers, insured organizations, health care plans, and employees to be easily recognized.
- Simple electronic transmission of HIPAA standard transactions.
- Efficient coordination of benefit transactions.
Who May Obtain an NPI?
All health care providers should receive an NPI (that is, doctors, manufacturers, hospitals, and others). As defined in 160.103 of the 45 Code of Federal Regulations, health service providers, individuals, or organizations providing health care (CFR) must have an NPI.
Who Must Obtain an NPI?
NPI must be obtained by entities, health care professionals, and organizations that HIPAA covers. Entities covered by HIPAA are those who, in electronic form, perform healthcare data transactions. It can be a clearinghouse for health insurance as well as any organization for a health plan.
Note: – According to HIPAA, if you share the personal health information of a person electronically, then you are a covered health care provider.
Who May Not Obtain an NPI?
An NPI may not be pursued by any organization that does not meet a health care provider’s criteria as specified in 45 CFR 160.103. No entity that does not meet a healthcare provider’s requirements as defined in 45 CFR 160.103 seeks an NPI. This involves payment systems, value-added networks, insurance policies, health care clearinghouses, non-emergency transportation providers, etc.
How do you find my physician’s NPI Number?
The National Plan and Provider Enumeration System (NPPES) allocate NPIs, retain and update NPI health care provider records, and disseminate the NPI and NPPES Downloadable File Registry. There are also numbers of websites where the NPI number can be found online, and these are as follows.