CMS Urges Healthcare Providers to Apply for NPI

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WASHINGTON—Healthcare providers—including those in dialysis— have less than a year to obtain a National Provider Identifier from the Centers for Medicare & Medicaid Services.

The NPI must be used in all standard healthcare transactions no later than May 23, 2007. Therefore, CMS is urging healthcare providers to apply for an NPI well before May 22 of next year. Smaller health plans have until May 23, 2008.

The Health Insurance Portability and Accountability Act of 1996 mandated the Secretary of Health and Human Services to create and adopt a single, unique identifier for healthcare providers. HHS Secretary Mark McClellan published the final rule for NPIs in January 2004.

“The NPI will replace healthcare provider identifiers that are in use today in standard transactions,” McClellan wrote in a letter to providers last year. “Implementation of the NPI will eliminate the need for healthcare providers to use different identification numbers to identify them when conducting standard transactions with multiple health plans.”

According to CMS, the NPI is a single, 10-digit number that will not expire or change.

In addition to dialysis providers, CMS said healthcare providers also include physicians, dentists and pharmacists, and organizations such as hospitals, nursing homes, pharmacies and group practices.

There are three ways healthcare providers can apply for an NPI:

  1. Apply online at https://NPPES.cms.hhs.gov
  2. Call the “NPI Enumerator” at (800) 465-3203. Request a paper application form, complete it, and mail it back to CMS
  3. Apply for bulk enumeration. This allows a CMS-approved Electronic File Interchange Organization to obtain a number of providers’ NPI

CMS provided the following tip on its Web site: “When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payers. If reporting a Medicaid number, include the associated state name. This information is critical for payers in the development of crosswalks to aid the transition of NPI.”

Medicare says its fee-for-service program began accepting the NPI from providers in January. More information can be found at the CMS NPI Web site.

In the letter, McClellan said the NPI is part of a broader overhaul of the CMS system to improve electronic transactions in healthcare. He said national standards would encourage electronic communication in healthcare, which will simplify administrative burdens.

“These national standards will make electronic data interchange a viable and preferable alternative to paper processing for healthcare providers and health plans alike,” McClellan wrote.

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