• About Health Care -- March 2004
  • March 26, 2004
  • Law Firm: McGlinchey Stafford, PLLC - New Orleans Office
  • Continuing its efforts to standardize health care transactions automation, the Centers for Medicare and Medicaid Services (CMS) released its final rule adopting the Health Insurance Portability and Accountability Act (HIPAA) standard unique health identifier for health care providers. This national provider identifier (NPI) rule is effective on May 23, 2005, and most providers who are covered entities and submit standard electronic transactions under HIPAA are required to obtain and use the NPI within two years of the effective date. However, all health care providers are eligible for NPI numbers. Providers will not be charged to be assigned a number or to update their data.

    As of the effective date, any health care provider may request a new ten-digit NPI number for use in all health care transactions, whether federal, state or private. The number itself will not provide information about the provider. Each provider will have only one number which is to remain with the provider throughout the provider's years as a provider. One entity will assign the NPIs under the direction of the Department of Health and Human Services (HHS) and there will be a new system, the National Provider System, that will maintain the provider data. HHS will exercise overall responsibility for oversight and management of the NPI system.

    Currently, health plans -- including plans that are employer sponsored -- assign one or more identifying numbers to each provider with whom they conduct electronic business. The NPI number is intended to replace the multiple identifier codes assigned providers by different health plans or even within the same health plan, and will ensure that each provider has one number to be used in all electronic transactions with health plans.