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What is the NPI?

____________________________________________ The NPI is one of the required HIPAA identifiers to be used in standard electronic health care transactions. It is a unique and permanent healthcare provider identifier consisting of 10 numeric positions, preceded with 80840, per the National Committee for Information Technology Standards .284 standard An NPI is inactivated only upon death or dissolution of the health care provider.
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What is the NPI?


____________________________________________ NPI will replace existing legacy provider numbers used for billing, servicing, referring, etc. including: UPIN Medicaid Provider Number Medicare Provider Number Blue Cross and Blue Shield Numbers Other internal proprietary healthplan provider numbers
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What the NPI is NOT


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An NPI will not:
Guarantee reimbursement by health plans Enroll providers in health plans Make providers covered entities Require providers to conduct electronic transactions

While it is required for HIPAA EDI, it is not required for internal use within a healthcare organization as long as it is able to be mapped to internally used legacy identifiers but relationships must be one to one, one to many, or many to one. Not many to many.
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Who Can Get an NPI?


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Any health care provider


Both covered and noncovered (per HIPAA definition) entity providers Individuals: Physicians, dentists, nurses, chiropractors, others Organizations: Hospitals, ambulatory care facilities, laboratories, HMOs, group practices, others

Subparts of providers
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Who Cannot Get an NPI?


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Non-healthcare providers such as:


Social service providers under a Medicaid Waiver program Housekeepers Non-medical transportation.

This means that many providers (nonhealthcare) on payer and other healthplan networks will not require an NPI
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NPI Applications - Individuals


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Required: name, gender, address/telephone, Taxonomy Code(s), date of birth, State/country of birth, contact persons name/telephone Situational: license number(s)/State(s) (required for certain Taxonomy Codes) Optional: SSN/ITIN, name prefix/suffix, other name(s), credential(s), other identifiers
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NPI Applications - Organizations


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Required:

name, address/telephone, Taxonomy Code, authorized officials name/telephone, contact persons name/telephone EIN (required if provider has one), license number(s)/State(s)(required for certain Taxonomy Codes) other name(s), other identifiers

Situational: Optional:

Provider Taxonomy
____________________________________________ Used by a provider (individual, group, or institution) to identify and self declare with the NPI Enumerator their specialty category(ies) as associated with a single NPI, i.e., providers may have one or more than one taxonomy associated to them. When determining what taxonomy code or codes to associate with a provider, need to review the requirements of all the trading partners with which the code(s) are being used.

Provider Taxonomy
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The Individual Category of providers includes: Physicians Behavioral Health and Social Service Providers Chiropractic Providers Dental Providers Dietary and Nutritional Service Providers Emergency Medical Service Providers Eye and Vision Service Providers Nursing Service Providers Nursing Service Related Providers Other Service Providers Pharmacy Service Providers Physician Assistants and Advanced Practice Nursing Providers Podiatric Medicine and Surgery Providers
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Provider Taxonomy
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Provider Type (1st level)


A major grouping of service(s) or occupation(s) of health care providers. Examples include:
Allopathic & Osteopathic Physicians Dental Providers Hospitals Etc.

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Provider Taxonomy
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Classification (2nd level)
A more specific service or occupation related to the Provider Type, often based upon the General Specialty Certificates as issued by the appropriate national boards, e.g.., within Allopathic & Osteopathic Physicians, Classifications would include:
Allergy and Immunology Anesthesiology Dermatology General Practice Internal Medicine Obstetrics and Gynecology Etc
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