The National Provider Identifier, or NPI, is a special 10-digit identification number that is used to identify any individual or organization that can be defined as a healthcare provider in the United States of America.
Under the Health Insurance Portability & Accountability Act 1996 (HIPAA), individuals or organizations who are health care providers or suppliers and they bill Medicare for the services that they provide are required to have a National Provider Identifier (NPI) number.
The government of the United States of America has a special federal agency under the Department of Health & Human Services known as the Centers For Medicare & Medicaid Services (CMS), and this federal body is responsible for issuing all NPI numbers to healthcare providers. Earlier the Unique Physician Identification Number (UPIN), a 6-digit alpha-numeric identification key, was being used by the government of the USA to identify Doctors in the country, but later on, it was replaced by the NPI number in the year 1996 under the HIPAA Act.
How to Lookup NPI Number?
A dedicated website, NPI Checker (https://www.npichecker.com), can be used to find an NPI. Their database is constantly updated with the latest NPI information provided by individuals and organizations. This is one of the best website for NPI number Lookup.
It also provides information like contact details, license numbers, specialization, etc. So, NPI search is super easy with this website.
What Are The Benefits Of NPI And Why Was It Introduced?
Like all government initiatives, the US government brought this identification number to make it easier for these healthcare providers to send and receive electronic data.
These kinds of data transfer may include things like
- Detailed information about premium payments
- Status for claims of medical benefits
- Medical benefit claim and encounter information
- Payment information
- Authorization & referrals
- Information regarding eligibility and enrolment for medical benefits, etc
All the above-mentioned data transfers are considered as HIPAA standard transactions.
The NPI number is the only number healthcare providers need to conduct a such electronic data transfer. Other identifiers, such as the National Supplier Clearinghouse (NSC), Survey Provider Enhanced Reporting (CASPER), Provider Transaction Access Number (PTAN), and Quality Improvement Evaluation System (QIES), are not required.
As a result, it reduces administrative burden and maintains a single identification number for all types of electronic data transfers that fall under the HIPAA standard transaction category.
The ease of transfer of data between 2 parties was the primary reason for why the government introduced the NPI identification number. However, NPI number has a few more crucial advantages, which are as follows.
- It serves as a unique and common identifier for all healthcare organizations and healthcare plans. Healthcare facilities are typically very important for the elderly or people of generally 65 or older, so this NPI also reduces their difficulties when they need to track a particular healthcare provider or organization. NPI acts as a single standard way of identifying rather than using multiple identifiers, so this, in turn, reduces the burden of the government to keep a record of all these individuals or organizations through multiple different types of identifiers.
- Even if the name, address, or other important details gets changed, the NPI assigned to that person or organization will remain the same. In turn, this greatly reduces the stress associated with worrying that the NPI number will change if any other important information about that specific person or entity is bound to change.
- Thus, we can say that the NPI number simplifies the transactions or process involved when receiving medical benefits. When an individual is willing to receive medical benefits from any health care provider, the process or transactions through which the individual will have to go in order to get the medical benefit get simplified because of the use of NPI numbers.
- The use of an NPI number also simplifies the billing process. From the customer's perspective, there is no need to track, report, or maintain multiple identification numbers from various healthcare providers, which helps to reduce a significant amount of burden.
Who All Qualify For Or Are Required To Have An NPI Number?
Now that we have a good understanding of what an NPI number is, why it was created, and what the key benefits of this unique identification number are, let's understand in detail which specific individuals or organizations providing health care services are eligible for or are required to have an NPI number.
When it comes to healthcare providers, there are primarily two types: Type 1 and Type 2. Based on these two types, NPI numbers are assigned, which are clearly explained in the following points.
- All individuals or sole proprietors who provide health care services and are covered by HIPAA Act are defined as Type 1 Health care providers, and they are eligible as well as required by the law to have NPI numbers. These Type 1 category of health care providers include individuals like Dentists, physicians, chiropractors, pharmacists, nurses, physiotherapists, psychologists etc.
- Any business entity, whether a large corporation, a Limited Liability Company (LLC), or an ordinary incorporated organization, that directly provides health care services and is covered by the HIPAA act is defined as a Type 2 Health care provider, and these entities are eligible for and required to have an NPI number. If that organization has a Subpart that is not a separate legal entity on its own and does not conduct HIPAA Standard transactions on its own, then, in that case, the Subpart must share the main Organization's common NPI, otherwise, it is required to have an NPI number of its own. These Type 2 health care providers include organizations and businesses like clinics, laboratories, nursing homes, hospitals, pharmacies, suppliers of medical equipment, etc.
The two types mentioned above are the basic classifications of individuals or organizations covered by the HIPAA Act who are eligible and must have their own NPI numbers. However, there are a few things we must keep in mind when determining who is eligible and should have their own NPI number, which is as follows.
- A sole proprietor or an individual who provides health care services and has multiple offices in different locations, as well as employees, is still classified as a Type 1 health care provider and is only eligible for one NPI number with which he or she will be identified.
- When it comes to Type 2 health care providers, non-emergency transportation services, billing services, and various types of health plans are not considered health care service providers and thus are not eligible for an NPI number and are not required by law to have one. Also, an organization may have Subparts operating from various other locations. In that case, it will be identified with the NPI of its parent organization. However, if that Subpart is conducting HIPAA Standard Transactions completely independently from its parent organization, in that case, that Subpart will require its own separate NPI number.
How Do I Obtain Or Apply For An NPI Number?
There are mainly three ways in which you can apply for the NPI number
1st Method – Online Application
Nowadays, since everything in the Internet era is done online, you can easily apply for an NPI number online and get the entire process done with ease. Let's now understand in greater detail, step by step, how to apply for and obtain an NPI number online.
- The first step is to visit the National Plan & Provider Enumeration System (NPPES) website, where you will have to create a username along with a password so that it can be used to log into the website.
- If you want online assistance, then there is a help tab on the top right corner of the website. You can access it if you need any assistance.
- Click on the new NPI application, carefully read the terms and conditions, and begin providing important details such as personal information, taxonomy, or license information, and also, provide contact information for the person who will be contacted if an inquiry about the application arises.
- After providing these details, a certification statement will be generated. Once you have read it, you must click on submit application. The processing of your application has now begun, and you will also receive an email regarding your NPI number after approximately two weeks.
2nd Method – Offline Paper Application
The second method involves downloading the application form or asking for a hard copy, filling it out, and mailing it. You only need to download the paper application form from the website www.cms.hhs.gov/NationalProvidentStand/, fill it out with the necessary information, and mail it to the address listed on the form. In order to get the hard copy of the application form delivered to your address, you can contact 800-465-3203 or send and email to [email protected].
3rd Method – Give Permission to EFIO
In this last method, you can give permission to Electronic File Interchange Organization (EFIO) to send application data through the bulk enumeration process, and by this method, you authorize any trusted organization or an employer to get an NPI number for you through bulk enumeration process.
Conclusion
Thus, in the end, we can conclude by saying that NPI is a very convenient standard, unique 10-digit identification number that is used to track or identify any individual or organization that offers health care services and is covered by the HIPAA Act. This one-of-a-kind identification number replaces all other pointless alphanumeric or numeric identifiers and serves as a single standard identifier that benefits the government and healthcare providers. The government can track all HIPAA-covered healthcare service providers with just one number, saving them time and effort. Healthcare providers can easily obtain NPI numbers for themselves if they are eligible and don't have to maintain multiple identification numbers.
References
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“NPI Number Lookup.” NPI Lookup - Search and Find NPI Number (NPI Registry), www.npichecker.com. Accessed 23 Nov. 2022
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“NPPES NPI Registry.” NPPES NPI Registry, npiregistry.cms.hhs.gov/search. Accessed 23 Nov. 2022.
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"National Provider Identifier." Wikipedia, Wikimedia Foundation, 26 Oct. 2022, en.wikipedia.org/wiki/National_Provider_Identifier. Accessed 23 Nov. 2022.
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“NPI Lookup: National Provider Identifier (NPI) Checker | Common tools” Commontools.org, www.commontools.org/tool/npi-number-lookup-33. Accessed 23 Nov. 2022.