After May 23, 2007, all individuals and organizations identified as healthcare providers are required to obtain a National Provider Identifier (NPI) number as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This identifying number will be used by HIPAA covered entities: health plans, health care clearinghouses, and health care providers conducting electronic transactions.
Previously, health care providers have applied for and been assigned different numbers that identify them to various health plans. This national approach is intended to provide better data collection capability. The NPI is a 10-digit standard healthcare provider number that will be required by all health plans to identify you regardless of your state and practice specialty. All HIPAA-covered entities except small health plans must begin using the NPI on May 23, 2007; small health plans have until May 23, 2008.
A small health plan is defined as one that has annual revenues of $5 million or less. Your NPI number will never change and will be a lifelong identifying number for you across healthcare plans, public and private insurances.
Your NPI will identify you as a healthcare provider but you still need to properly enroll with various 3rd party payers, including Medicare. The health plans with whom you do business will instruct you as to when you may begin using the NPI in standard transactions. Check with each individual payer to verify their enrollment process procedures. It is important that you apply for and obtain an NPI before making changes to existing payer contracts or enrolling in programs such as Medicare.
For example, under the Medicare program, a provider still must contact the appropriate Medicare Contractor (Fiscal Intermediary, Carrier, etc) in order to obtain information and complete the Medicare enrollment process. Payers will discontinue using their specific numbers at different times. Until you are instructed to discontinue using payer specific identifiers, you should use both the NPI and any payer specific identifiers in standard transactions.
Occupational therapists are allowed to enroll as providers in the Medicare program. However, both occupational therapists and occupational therapy assistants are considered professionals and need to obtain individual identifying NPI numbers. Examples of organizations that may apply for a NPI include but are not limited to: hospitals, home health agencies, group practices, clinics, supplies of durable medical equipment, and nursing homes.
For information about the NPI visit: http://www.cms.hhs.gov/apps/npi/01_overview.asp. Apply online or call 1-800-465-3203 to request a paper application.
The Centers for Medicare and Medicaid Services (CMS) has written a letter to providers introducing the NPI. Read the letter.
The final rule for the NPI was announced on January 23, 2004. Read the entire rule.