FAQ: National Provider Identifier (NPI)NPI News: As a result of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the federal Department of Health and Human Services mandated the use of the National Provider Identifier (NPI), which is a standard unique identifier for health care providers. More information and latest news about implementation. Show
General1. What is the National Provider Identifier (NPI)?
2. What is the National Provider Identifier (NPI) Requirement? 3. What are the rules for obtaining a National Provider Identifier (NPI)?
4. Do I need an NPI if I only bill on paper or via the Web? 5. How do I apply for a National Provider Identifier (NPI)?
The NPI Enumerator Call Center Telephone Number is 1-800-465-3203 Contingency Plan1. Can I submit claims using only my legacy number until May 23, 2008? No. Sometime prior to May 23, 2008, DHS will move into the NPI Dual Strategy phase. During this phase claims submitted with only the 13-digit PROMISe Provider ID (legacy number) will be denied. You should be using your registered and validated NPI number. 2. Why should I submit claims with both the legacy number and the NPI number at first? 3. Does the contingency plan mean I do not have to use the new paper forms until later? Implementation Dates1. When did the Department of Human Services transition to the NPI? The Department of Human Services has implemented a contingency plan supporting a Dual Strategy approach. Information on the NPI Contingency Plan is contained in the NPI Contingency Plan presentation. 2. When will the Department of Human Services require NPI on Paper Claims? 3. When will the Department of Human Services begin returning NPIs only on the 835 Institutional and Professional? 4. When
will the Department of Human Services begin adjudicating claims based on the NPI? Pharmacy1. Do pharmacists and pharmacies need NPI numbers? 2. If a payor requires that the prescriber be identified on a pharmacy transaction,
what number should a pharmacy submit on a pharmacy transaction when a prescriber does not have an NPI? 3. What am I permitted to submit in the billing provider segment? 4. What am I permitted to submit in the prescriber segment? 5. How do I validate the NPI number on a transaction? (6) Can the NCPDP enumerate Pharmacies? (7) What numbers will be returned on the outbound 835 transaction? (8) Will the prescribing field on an NCPDP transaction require an NPI number? NPI Registration(1) How
can I register my NPI information with the PA Department of Human Services? (2) How will Medical Assistance want to receive the organizational taxonomy codes for each NPI subpart number? (3) Will providers who have secured NPI numbers through bulk enumeration be able to submit an NPPES file to DHS? (4) Will provider organizations that have a large number of providers be able to submit an Excel file to DHS for registration? (5) How is DHS going to crosswalk our current 9 digit number with the 4 digit suffix's to the required NPI? (6) Will
we need to obtain NPI's for each of our current Medical Assistance numbers and Service locations? (7) What should a health care organization do if they are required by another payor to have an NPI # for subpart locations that are not enrolled
in Medical Assistance? (8) Do Private Duty/Homecare agencies need an NPI? (9) Would you recommend that both groups and individuals obtain an NPI? (10) Where can I find the Taxonomy Codes Crosswalk to DHS Provider Types and Specialties? (11) What if I cannot find the appropriate Taxonomy Code when registering my NPI? (12) How can I close Service Locations that are duplicates or are no longer being used for
billing? (13) I am unable to find taxonomy codes for all of my specialties on the DHS Provider Type/Provider Specialty to Taxonomy Crosswalk. Does this mean that services submitted on claims for those specialties will not pay? Claims(1) Are your new Billing and Companion Guides available?
(2) Are you using our inbound NPI data to populate your system? (3) If no, how do you plan on populating NPIs into
your system? (4) When will the Department of Human Services begin adjudication of claims based on the NPI? (5) Are providers required to submit their 13-digit PROMISe Provider ID number and an NPI for a transition period? (6) Will the Department of Human Services require Taxonomy Codes on the claim form? (7) Will the 835 (Electronic Remittance Advice) contain the NPI that is sent to the Department of Human Services on an incoming claim? (8) Will you strictly use the
NPI, or 13-digit PROMISe Provider ID number, via "back end mapping" to determine how to pay claims and to whom? (9) Will different fields be
used on claims to determine how to pay claims (i.e., location, group, taxonomy, bill type etc.)? If so, what fields/data elements will you use? (10) Which fields will be used for those NPIs? Will
taxonomies be required on claims?
(11)
Currently, some forms require license number (Prior authorizations, Program exceptions). Will it remain that way? How are Durable Medical Equipment (DME) handled?
(12) Will NPI take the place of license number? (13) Will the Department of
Human Services still be using the PROMISe Provider ID number and the new NPI's used to identify providers and sub-parts? (14) Which
fields on the claim submission will be used for NPIs? (15) Will the referring and billing provider NPIs be required? (16) Do you allow testing for
NPI? (17) Will the paper remittance advice (RA) contain the NPI number? (18) How are payments being handled for claims with new NPI numbers? Subparts(1) What is a Subpart? (2)
What are the Department of Human Services's recommendations for Subparts?
(3) If we choose to enumerate our Subparts further than we currently have today with payer legacy numbers, are you going to require enrollment of our additional subparts? Taxonomy Codes(1) What are Taxonomy Codes? (2) Is the Department of Human Services planning on requiring Taxonomy Codes on claim
forms? (3) I am unable to find taxonomy codes for all of my specialties on the DHS Provider Type/Provider Specialty to Taxonomy Crosswalk.
Does this mean that services submitted on claims for those specialties will not pay? Additional Resources(1) Where can I find NPI information on the Department of Human Services's Web site? (2) Where
can I learn more about the NPI? (3) What is the National Plan and Provider Enumeration System (NPPES)? (4) What is FOX Systems Inc.? (5) Does FOX Systems have recommendations regarding subparts? 6. What is the
Workgroup for Electronic Data Interchange (WEDI)? Which HIPAA standard requires that all providers secure a national provider number?The NPI Final Rule, published on January 23, 2004, established the NPI as this standard. Covered entities under HIPAA are required by regulation to use NPIs to identify health care providers in HIPAA standard transactions.
What forms of PHI are protected under HIPAA's standard 2?The HIPAA Privacy Rule protects most “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, on paper, or oral. The Privacy Rule calls this information protected health information (PHI)2.
Which HIPAA standard requires providers to protect electronically transmitted in otherwise stored personal health information?The Security Rule protects a subset of information covered by the Privacy Rule, which is all individually identifiable health information a covered entity creates, receives, maintains or transmits in electronic form. The Security Rule calls this information "electronic protected health information" (e-PHI).
What forms of PHI are protected under HIPAA's standard 2 quizlet?Protected Health Information (PHI) is any written, spoken, or electronic form. (HIPAA' s Standard 2 covers Protected Health Information (PHI) in any written, spoken, or electronic form.
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