NPI Compliance Date
The Centers for Medicare & Medicaid Services (CMS) recently announced that it is implementing a contingency period for entities that will be unable to comply with the National Provider Identifier (NPI) regulatory requirements of the Health Insurance Portability and Accountability Act (HIPAA). The compliance date for these entities has been extended to May 23, 2008.
Until then, providers may continue to submit EDI claims using the provider's SSN or federal tax ID as the primary identifier, along with their UHA assigned PIN as the secondary identifier, until they are ready to submit using their NPI number.
Once a provider wishes to begin using their NPI number, they must first set up a test file transfer. Send an email to hipaa-edi@uhahealth.com with subject line: NPI TEST, and include their provider name and a contact phone number in the email body. Then send a test EDI file using the NPI number as the primary identifier, with the UHA assigned PIN as the secondary identifier. If the test goes successfully, the provider may continue to send live claims using their NPI number.
After May 23, 2008, all EDI claim files should contain NPI numbers for all rendering and billing providers. UHA assigned PINs should be removed. Any EDI claims not containing NPI numbers will be considered non-compliant and will be returned without processing.
What is NPI and how will it affect my business with UHA?
The National Provider Identifier (NPI) is a standard unique identifier, mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), for health care providers to transmit health information electronically in connection with HIPAA standard transactions. The NPI will replace health care provider identifiers that are currently in use, and eliminate the need to use different identification numbers with multiple health plans.
The following are eligible to apply for and receive an NPI:
- Individuals: physicians, dentists, and pharmacists
- Organizations: hospitals, nursing homes, pharmacies, and group practices
Contact Provider Services to coordinate using your NPI in your transactions with us.
How do I apply for an NPI?
Apply for your NPI in one of three ways:
- Online. The online application process is fast and easy. Apply now at https://nppes.cms.hhs.gov.
- By Mail. Complete a paper application and send it to the Enumerator. A copy of the application and instructions are available at https://nppes.cms.hhs.gov, or you can call the Enumerator at 1-800-465-3203 or TTY 1-800-692-2326 to receive a copy.
- Third Party Organization. With your permission, an organization may submit your application in an electronic file. This could mean that a professional association, or perhaps a health care provider who is your employer, could submit an electronic file containing your information and the information of other health care providers.
When gathering information for your application, be sure that all of your information is current and accurate. Once you receive your NPI, safeguard its use.
For more information and complete details on obtaining an NPI, or learning more about its use, please refer to http://www.cms.hhs.gov/NationalProvIdentStand/.