Effective on May 23, 2007, all covered healthcare providers will be required to have and use a National Practitioner Identifier (NPI) number in order to receive payment from Medicare, Medicaid and private insurance payors for all standard transactions.
In addition, physician offices will be required to obtain and utilize NPI numbers for referral sources when referring patients to subspecialists, as well as to outpatient and inpatient services.
“Thus it is essential that practices obtain the necessary NPI numbers for all practitioners, including doctors, nurse practitioners and physician assistances, and begin the process of collecting the NPI numbers from referral physicians, labs, and other referral sources,” said Marta Alonso,
An NPI number is a 10 position numeric identifier assigned by the Department of Health and Human Services. The numbers – which are utilized by a practitioner throughout his or her career much like a social security number – can be secured by contacting the National Plan and Provider Enumeration System (NPPES). The system can be contacted by calling 1-800-465-3202 or by going online at https://nppes.cms.hhs.gov, via email at firstname.lastname@example.org or by mail at NPI Enumerator P.O. Box 5065, Fargo, ND 58108-6509.
“Once providers have received their NPI numbers they should share them with other providers. In fact, in current regulations, all providers must share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes, including designation of ordering or referring physicians,” said Alonso.
Physician practices should also contact commercial, Medicare and Medicaid payors to determine when they will begin testing the new NPI number system and to find out what information the payors need from the practice.
Anyone needing advice for navigating the new system is asked to contact:
Miami Children's Hospital
MD Direct Connect: (305) 663-6840
Fax: (786) 268-6510