National Provider Identifiers: Finally A "Good Thing" For Providers

By: Ronald E. Nyman, Esq.

It seems in the past few years, providers have found themselves burdened by numerous new regulations ranging from billing compliance to privacy and security. Upset about writing that 200-page HIPAA privacy manual? Have you had it with figuring out when you need an authorization to disclose patient health information? Did I really need to go to medical school - maybe law school would have done the trick in order to understand the Byzantine healthcare regulations that government officials enact each year. Have you started grimacing yet? Before you do, let me tell about one initiative that the government got right - the National Provider Identifier (NPI).

As part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Congress required the Secretary of Health and Human Services to adopt a standard unique identifier for all healthcare providers and organizations. The Secretary published a final rule on January 23, 2004, which adopted the NPI as this standard identifier. The government is now strongly encouraging individual providers, hospitals and physician groups to fill out an online application in order to be issued their NPI. And I would also encourage all providers to do so as well.

Why is the NPI a good thing? Not to plagiarize Martha Stewart, but the NPI is a good thing for all providers. Look no further than how you are currently doing your billing. For example, if you bill Blue Cross/Blue Shield you need to make sure that your unique carrier provider number is on the claim. Same thing for Medicare, Medicaid, ConnectiCare, Oxford and Health Net - each one requires you to include a provider number on the claim and each number is different for each carrier. What if you have an office in New York as well as Connecticut? You will need a Blue Cross/Blue Shield number to bill Anthem in Connecticut and a different Blue Cross/Blue Shield number for Empire in New York. And so on and so on - until the NPI came along.

The NPI is the one number that is permanently yours and stays with you regardless if you change practice or location. More importantly, by May 23, 2007, all major commercial carriers, the Blues, Medicare and Medicaid must accept your claims with the NPI. (Small commercial carriers have an extension to comply by May 23, 2008). You will no longer be required to bill a carrier using that carrier's unique provider number. In other words, one size fits all!

No more concerns about loading all those different provider numbers into your software or maintaining those numbers on an Excel spreadsheet. All of your electronic exchanges (i.e., claim submission, remittance posting, etc.) will be standardized under your single NPI.

But in order to seize these benefits you first need to obtain your NPI. You can do this online by going to https://nppes.cms.hhs.gov. On this site, you will find instructions on how to fill out an application to receive an NPI. According to the government, once you submit a properly completed application, you should receive your NPI approximately 10 days later. Keep in mind that if you do not have an NPI by May 23, 2007, you will no longer be able to send electronic claims to carriers. And, as Martha would say, that would not be a good thing.

This article first appeared in the November/December 2005 issue of News Capsule, a publication of The Fairfield County Medical Association.