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The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will need to use the NPIs in the administrative and financial transactions adopted under HIPAA.
If you’re not yet sending claims with an NPI number, you need to begin doing so as soon as possible, the new drop dead date for converting to NPI usage is May 23, 2008. Although CMS has the authority to move that date up. The current time-line is part of CMS’ contingency plan that went into effect when it became clear that physicians could not meet the original NPI deadline, which was May 23, 2007.
If you are a health care provider who bills for services, you probably need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy, and free. If you delay applying for your NPI, you risk your cash flow and that of your health care partners as well.
Physicians should take advantage of regular CMS updates about the NPI and other Medicare-related issues by signing up to receive information via CMS’ e-mail mailing lists. Although the agency currently is updating its mailing list service, physicians can bookmark the e-mail list sign-up Web page and check back later to set up their subscriptions.
Here are some frequently asked questions about the NPI that will help answer most of your common questions.
Does NPI only affect Medicare and Medicaid providers and their claims?
No. All healthcare providers who send or receive standard electronic transactions need to obtain an NPI. Failure to obtain an NPI may be viewed as a violation of the good faith provisions of CMS’ contingency guidance.
What about NPI for those who file paper claims?
If a provider only bills claims on paper, providers need to be aware that some health plans, including Medicare, are requiring the use of NPI’s on paper transactions (such as paper insurance claims). In addition, if a provider refers patients to another provider who is filing claims electronically, that practitioner will need to obtain the referring provider’s NPI in order to process the electronic claim. In short, all healthcare providers are encouraged to apply for and share their NPI.
What does an NPI look like?
An NPI is a 10-digit number. All characters are numeric. The first digit is always a 1, 2, 3 or a 4. The first 9 characters are the identifier and the last character is a check digit. The check digit helps detect invalid NPI’s. For example, if a provider’s Tax ID is 123456789, he or she cannot start sending 1234567890 and expect it to be processed as an NPI.
What about insurance carriers?
Providers should contact their insurance carriers to find out what the carriers’ specific enrollment requirements are. Some carriers may take this information over the phone; some may require notification on letterhead or may have a form that needs to be filled out.
How do I get my NPI number?
If you don’t already have your NPI number, you can apply for an NPI number by calling the National Plan and Provider Enumeration System (NPPES) at 800-465-3203 or send an e-mail to
I’ve heard about a May 23rd deadline but then I heard that it was moved. Which is correct?
CMS (the Centers for Medicare & Medicaid Services) announced a contingency plan on April 2, 2007. It was determined that the percentage of providers outputting NPI information was too low. Providers and payers now have additional time to comply (through 05/23/2008), as long as they are making a good faith effort. This means that providers who were outputting both an NPI and a legacy Medicare ID should continue doing so. Providers who have obtained an NPI, but haven’t been using it, should do so now as long as the payer and clearinghouse have been previously
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