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National Provider Identifier (NPI) Our thanks to Past President Margaret Brady, PhD, RN, CPNP for providing the answer to the question. Question: Is there a standard unique identifier for health professionals? Answer: The Centers for Medicare & Medicaid Services (CMS) announced the adoption of the National Provider Identifier (NPI) as the standard unique health identifier for health care providers to use in filing and processing health care claims and other transactions. A final rule establishing the NPI as the standard unique health identifier was published on January 23 in the Federal Register became effective on May 23, 2005. The standard unique health identifier is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NPI is a new number that is issued through the National Provider System, which has been developed by CMS. The NPI replaces all 'legacy' identifiers that are currently being used. Use of the NPI will reduce costs and improve efficiency in the nation's health care system by eliminating the need for health care providers to maintain, keep track of, and use multiple identification numbers assigned by the various health plans they bill. All health care providers, whether or not they are covered entities under HIPAA, are eligible to be assigned NPIs. Non-covered providers may obtain NPIs. All covered health care providers must obtain NPIs. Health care providers are covered entities if they transmit any data in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard. Covered entities must use NPIs in standard transactions no later than the compliance dates. The compliance dates for all but small health plans is May 23, 2007. The compliance date for small health plans is May 23, 2008. A health care provider will be assigned only one NPI, and that NPI will not change over time. Adoption of the standard health care provider identifier enables a provider to use only one identifier as its NPI to identify itself in all standard transactions. Adoption of NPI is the latest step in implementing the administrative simplification provisions of HIPAA. The Secretary already has adopted standards for electronic transactions and code sets, for the privacy and security of certain individually identifiable health information, and for the unique health identifiers for employers. In the future, the Secretary will adopt standards for unique identifiers for health plans and for claims attachment transactions. All health care providers should apply for NPIs at this time and are required to obtain an NPI by May 23, 2007. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. Go to http://www.cms.hhs.gov/NationalProvIdentStand/ to apply for your NPI or call CMS at 877-267-2323.
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