Are you a HIPAA-covered healthcare provider? If so, take a number—a National Provider Identifier (NPI) number, that is. Because as of May 23, 2007, NPI numbers replace all legacy identifiers—including Unique Physician Identification Numbers (UPIN), Medicaid Provider Numbers, and Medicare Provider Numbers—as the go-to provider identification mechanism in the US healthcare system. But, as with any government-mandated requirement, NPIs have generated quite a few questions over the years. Here are some of the most common ones (along with answers), as adapted from this CMS resource and this APTA page:
Why do I need an NPI number?
Well, if you try to submit a claim without an NPI number, it almost certainly will be denied. And that doesn’t just go for Medicare claims; it’s also the rule for private payers. So, if you want to get paid for your services, you better get one of these 10-digit identifiers. Furthermore, as CMS explains, “NPIs may also be used to identify health care providers on prescriptions, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways.” But it’s not just another logistical hoop for healthcare providers to jump through; it actually is meant to save you time: NPIs help streamline the electronic claims submission process, as providers no longer have to track and submit insurer-specific identifiers.
How do I get an NPI number?
There are three ways to obtain an NPI number:
- Apply online through the National Plan and Provider Enumeration System (NPPES) page on the CMS website. There, you’ll set up an NPPES username and password, log in to your account, and fill out the electronic application. This is definitely the fastest and easiest way for an individual provider to get an NPI. The whole process should take about 20 minutes.
- Complete and mail an application to the address listed on the form, which you can access and print here. Don’t have a printer? No worries; you can request a hard copy of the application by calling the NPI Enumerator at 1-800-465-3203 or emailing email@example.com.
- Have an electronic file interchange organization (EFIO) apply for your NPI on your behalf. This method—also known as “bulk enumeration”—is geared toward submission of large batches of provider information. For more information on electronic file interchange, check out this CMS page.
If I’m part of a practice or facility that has a group NPI, do I also need an individual NPI?
Technically, no—but it’s strongly recommended that individual practitioners obtain their own NPIs, because, as this CMS resource states, “...there are situations where an individual NPI is specifically needed by some health plans to process claims.”
Can I change the information associated with my NPI?
Yes. In fact, if any provider details (e.g., the address of your practice) change, you must notify NPPES within 30 days. You can do this in one of three ways:
- access the online portal;
- print, complete, and mail this form; or
- call the NPI Enumerator at 1-800-465-3203 to request a form.
Would I ever need to get a new NPI?
Like a diamond, an NPI is forever—most of the time. As CMS explains, a provider’s NPI is “meant to be a lasting identifier, and is expected to remain unchanged even if a health care provider changes his or her name, address, provider taxonomy, or other information that was furnished as part of the original NPI application process.” If you need to update any of that information, you would follow the process outlined in the fourth item above. However, there is a very narrow set of circumstances in which you might need to obtain a completely new NPI—if the original one has been used fraudulently, for example. You also may need to obtain a new group NPI number as a result of “certain changes of ownership, the conditions of a purchase, or a new owner’s subpart strategies.”
Don’t see your NPI question on this list? Ask it in the comment section below, and we’ll do our darndest to dig up an answer for you. And for answers to other common billing questions, be sure to check out this FAQ.