Q: I have heard that health care providers will have to have something called an NPI number. Is this something an acupuncturist must have? And if I do need one, how do I get it?
A: The National Provider Identifier (NPI) is another requirement of the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Having an NPI is mandated and this number is assigned to all health care providers (including acupuncturists). The NPI is meant to supply all carriers and other entities with a universal number to identify specific providers. All health care plans (insurance carriers) also will have a universal identifier.
The purpose is to have one standard number for each health care provider to use for all health care plans. Consider that under the current system of insurance, you are likely using several different ID numbers to identify you or your office, depending on the specific insurer you are billing. As such, you may have to keep track of a set of completely different numbers assigned from Blue Shield, Blue Cross, and so on, that are only viable for a specific insurer. Obviously, this can be confusing, especially for the uninitiated.
The use of NPIs will not be fully in place or mandated until May 23, 2007. Many carriers are attempting to avoid a last-minute rush and are requesting that you supply the number if you already have it, so they can place it in their system and be ready for the 2007 implementation. Blue Shield has been actively doing this since mid-June. Medicare is also getting on line, as they are requiring that anyone who is applying for Medicare also apply to receive their NPI before they can complete their Medicare application.
The use of the NPI will certainly simplify how providers and insurers are identified, and should essentially eliminate the mistakes of using a number that was assigned from one insurer for another and delaying payment of that claim. To apply for an NPI, the Centers for Medicare and Medicaid services have made an online application available that should take about 20 minutes from start to finish. It certainly is something you should do now. DonÕt wait until the last minute, so as to avoid any interruption of billing or payment. To access the online application, go to https://nppes.cms.hhs.gov/NPPES. If you do not have Internet access, call (800) 465-3203 for an application.
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