The National Provider Identifier (NPI) is an Administrative Standard for the Health Insurance Portability and Accountability Act (HIPAA).
For covered health care providers, NPI is a unique identification number created to increase electronic health information transmission quality and efficacy.
Before submitting claims or performing other transactions as defined by HIPAA, you will need one. Both health plans use the 10-digit number, and it does not expire or change.
Why do I need an NPI number?
Well, if you attempt to file a claim without an NPI number, it will almost inevitably be refused. And it doesn’t only apply to Medicare claims; it’s also the law for private payers.
So, you better get one of these 10-digit identifiers if you want to get paid for your services. Also, as stated by CMS, “NPIs can also be used to identify prescription health care providers, coordinate benefits between health plans, inpatient medical record systems, in program integrity files, and other ways.”
But it’s not yet another bureaucratic hurdle to leap through for healthcare professionals; it’s intended to save you time: NPIs help streamline the process of filing electronic claims, so providers no longer need to monitor and request insurer-specific identifiers.
When should I apply for an NPI number?
If you are a health care provider or covered entity, you need to apply for an NPI number. According to HIPAA Act, NPIs will be assigned to health care providers who need them to submit claims or conduct other transactions. This includes:
• Physicians and other practitioners • physician/practitioner groups • institutions such as hospitals • laboratories • nursing homes • dental providers • suppliers such as pharmacies and medical supply companies and • any health care provider who transmits any health information in electronic form in connection with a standard transaction.
Who May Obtain an NPI?
All health care providers (that is, physicians, suppliers, hospitals, and others) may obtain an NPI.