N ational P rovider I dentifier Type 1 Workforce Training Month Day, Year The NPI will become the...
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Transcript of N ational P rovider I dentifier Type 1 Workforce Training Month Day, Year The NPI will become the...
National Provider Identifier Type 1Workforce Training
Month Day, Year
The NPI will become the standard, unique identifier for health care providers in HIPAA Transactions
DHHS/DIRM Projects Office - NPI Initiative 2
Purpose
• This training presentation is being delivered to educate workforce members on– National Provider Identifier Requirement
– How to Obtain an NPI
– How to Report NPI to Facility/Division
– NPI Resources Available
DHHS/DIRM Projects Office - NPI Initiative 4
Background
• The NPI is a HIPAA Administrative Simplification Standard– Transactions and Code Sets
– Security
– Privacy
– Identifiers• Unique Employer Identifier• Unique Health Care Provider Identifier (NPI) • Unique Health Plan Identifier – Proposed rule
pending
DHHS/DIRM Projects Office - NPI Initiative 5
• Published January 23, 2004• Requires the use of the NPI in standard
transactions to identify health care providers standard transactions no later than 5/23/07
• Replaces the use of proprietary and legacy provider identifiers in standard transactions
– Unique Physician Identification Number (UPIN)
– Medicaid ID
– Medicare ID
– BCBS, Aetna, etc. IDs
NPI Final Rule
DHHS/DIRM Projects Office - NPI Initiative 6
• Placed requirements on HIPAA covered entities
– Health plans (e.g., Medicare, NC Medicaid, BCBS)
– Health care clearinghouses
– Health care providers conducting HIPAA standard transactions • DMH/DD/SAS facilities• DPH State Lab and CDSAs• OES Schools
NPI Final Rule – cont’d
DHHS/DIRM Projects Office - NPI Initiative 7
• All health care providers who conduct any of the HIPAA standard transactions– Individuals – NPI Type 1
• These individuals furnish health care services that are billed using HIPAA standard electronic transactions or may initiate and / or receive referrals. This includes: – DHHS Workforce Members– Private Providers
– Organizations – NPI Type 2– Organization “Subparts” – NPI Type 2
• Components of organizations that conduct transactions separately from the rest of the organization
• Note – all “health care providers” as defined by 160.103 are eligible for NPI
Who Must Get an NPI?
DHHS/DIRM Projects Office - NPI Initiative 8
• List Provider Types Here
Who Must Get an NPI in This Facility?
DHHS/DIRM Projects Office - NPI Initiative 9
What is an NPI?
• 10 digit number• All numeric• Never changes
– Good for the life of the provider– May be deactivated/reactivated
• Does not itself convey information about the provider– Legacy provider numbers may have
“intelligence” that describes the provider type, specialty, and location
DHHS/DIRM Projects Office - NPI Initiative 10
Who Assigns NPIs?
• NPI Enumerator – HHS contracted with Fox Systems, Inc.– Process applications and assigns NPIs
– Maintains NPI data in the National Plan and Provider Enumeration System (NPPES)
– Furnishes NPI information upon request and in accordance with established guidelines• Privacy Policy available at
https://nppes.cms.hhs.gov/
DHHS/DIRM Projects Office - NPI Initiative 11
DHHS Approach to Workforce Enumeration
• DHHS HIPAA Oversight Committee Recommendation– DHHS not assume the responsibility to
submit NPI applications for workforce members
– Memo sent to DHHS Division Directors April 2006 (http://hipaa.dhhs.state.nc.us/hipaa2002/identifiers/identifiers.html)
• DHHS Policy under development to support decision
DHHS/DIRM Projects Office - NPI Initiative 12
Requirements for DHHS Workforce
• DHHS workforce members must– Apply for NPI by schedule required by
facility/division
– Report NPI data to facility/division NPI Contact
– Maintain data supplied to obtain NPI changes• Updates to be made within 30 days of change
– Report appropriate changes to facility/division NPI Contact
DHHS/DIRM Projects Office - NPI Initiative 14
Before You Apply• Collect the following information
– SSN or Individual Taxpayer Identification Number
– Date of Birth
– Country of Birth
– State of Birth (if Country of Birth is U.S.)
– Gender
– Mailing Address
– Practice Location Address and Phone Number
– Taxonomy Code(s)
– State License or Certification Information (required for certain Taxonomy Codes)
– Contact Phone Number and Email Address
DHHS/DIRM Projects Office - NPI Initiative 15
Taxonomy Codes Explained
• An additional, unique, 10 position number to be listed on NPI application – Minimum of one required; up to 14 allowable– Some require license/certification number
• Provides additional information on provider (replaces missing legacy ID “intelligence”)– Provider Type– Classification– Area of Specialization
• Situational use on transactions – requirement TBD by each health plan – DHHS assuming all plans will require
• Taxonomy Code list available atwww.wpc-edi.com/taxonomy– Use “Individual or Groups (of Individuals)” list
DHHS/DIRM Projects Office - NPI Initiative 17
How to Apply• Two options available at
https://nppes.cms.hhs.gov/– Paper Form
• Make a copy before mailing
• Keep notification letter of assigned NPI
– Electronic Form – Recommended • Self-assigned ID and Password – store in safe place
• Print every page before advancing
• Keep notification email of assigned NPI
• Helpful HINT: Review CMS NPI Viewlet before applying!– http://www.cms.hhs.gov/apps/npi/npiviewlet.asp
DHHS/DIRM Projects Office - NPI Initiative 19
What to Report
• Provide a copy of the NPI assignment letter/email
• Include Taxonomy Code(s) listed on application
• Give to NPI Contact designated by your Facility or Division
DHHS/DIRM Projects Office - NPI Initiative 20
Your NPI Contacts Are
• Name– Phone
– Email Address
– MSC Code
• Name– Phone
– Email Address
– MSC Code
DHHS/DIRM Projects Office - NPI Initiative 21
Reporting Schedule
• Facility/Division Schedule to be inserted here
DHHS/DIRM Projects Office - NPI Initiative 23
NPI Resources
• Centers for Medicare and Medicaid Services (CMS)– http://www.cms.hhs.gov/apps/npi/
01_overview.asp
• DHHS HIPAA Web Site– http://hipaa.dhhs.state.nc.us/hipaa2002/
identifiers/identifiers.html
– Contains Helpful Hints, FAQs, and other useful information
DHHS/DIRM Projects Office - NPI Initiative 24
NPI Resources – cont’d
• NPI Enumerator– https://nppes.cms.hhs.gov/
– 1-800-465-3203 or TTY 1-800-692-2326
– Can provide copies of NPI notification letter if lost