What is NPI?
The National Provider Identifier (NPI) is an Administrative Simplification Standard under the Health Insurance Portability and Accountability Act (HIPAA).
For covered health care providers, the NPI is a unique identifying number. In the administrative and financial activities required by HIPAA, covered healthcare providers, all health plans, and health care clearinghouses must use NPIs.
The NPI is a ten-position numeric identification that is devoid of intelligence (10-digit number). This means that the data don’t contain any further information about healthcare providers, such as where they live or what medical specialty they practice.
In HIPAA standards transactions, the NPPES must be used instead of traditional provider identifiers.
Covered providers must also disclose their NPI with other doctors, health plans, clearinghouses, and any entity that may need it for billing purposes, according to the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA).
What is the purpose of the National Provider Identifier?
The National Provider Identifier (NPI) is used to identify a health care provider in regular transactions like health insurance claims.
NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways.
Would I ever need to get a new NPI?
The National Provider Identifier (NPI) is intended to be a permanent identifier that will not change even if a health care provider’s name, address, provider taxonomy, or other information provided during the initial NPI application process changes.
There are some situations, however, in which an NPI may change such as when health care provider organizations determine they may need a new NPI due to, for example, certain changes of ownership, the conditions of a purchase, or a new owner’s subpart strategies.
There may also be occasions where a new NPI is required because the previous NPI was used fraudulently.
