Any healthcare provider, whether an individual or organization, will be assigned a National Provider Identifier (NPI). This is a 10-digit numeric identifier that can be shared with other healthcare providers, insurance companies and employers for the purpose of medical billing.
The use of NPI became standard with the introduction of the Health Insurance Portability and Accountability Act (HIPAA) in 1996. Before that, each healthcare provider was assigned a different number by payers such as insurance companies and federal agencies Medicare and Medicaid. This meant that a healthcare entity was using a different identification number depending on who the payer was. As you can imagine, this caused much confusion and often led to errors that resulted in delayed or denied payments. NPI streamlined the process and minimized errors.
Who Uses NPI?
Every healthcare provider must have its own unique NPI, which can then be used within the healthcare system. According to CMS.gov, ‘the NPI Final Rule requires health care providers who are organizations and who are covered entities under HIPAA to determine if they have “subparts” that should be assigned NPIs’.
To determine who needs an NPI, healthcare providers can refer to guidance under the NPI Final Rule. Typically, healthcare organizations, suppliers of federal programs, health plans, clearinghouses and other healthcare providers (private surgeons, dentists, and physicians), will require an NPI.
Organizations without an NPI will be unable to make claims with any healthcare plan or federal agency.
How are NPIs Assigned?
Organizations and individuals that require NPI can apply for them through the National Plan and Provider Enumeration System (NPPES). This is an online application and requires an account to be created through the Identity and Access Management System. Once the application has been completed, the NPI may be received in less than two weeks.
How to Find an NPI
If you want to find the NPI of an organization or the name of an organization based on an NPI, you can use online databases such as those found at Find-A-Code.com. NPI lookup is quick and easy to do, and the results will provide you with quite a bit of information. As well as the name of the organization and the NPI, you will find other details, including:
- Enumeration Date – this is the date that the NPI was assigned to the organization or individual.
- Address – this provides the primary address of the provider as well as a mailing address and secondary address if applicable.
- Status – this will tell you if the NPI remains active or has been deactivated.
- NPI Type – NPIs are assigned by type. Type 1 is for individuals and Type 2 is for organizations.
- Taxonomy – Providers must have at least one taxonomy code, but many have more than this. These codes describe the type of healthcare provider. One code must be designated as the primary code.
Unique National Provider Identifiers (NPI) are assigned to all healthcare providers to ensure that all payers are using the same number. The NPI of an organization or individual can be shared with other entities for billing purposes, helping to streamline the process and eliminate the risk of the same identifier being assigned to different providers by different health plans.
Insurance companies and federal payers will refuse to reimburse healthcare providers unless they have an NPI on all transactions, so it is necessary to apply for one as soon as possible. The process of applying for an NPI is quick and easy and identifiers are typically received within a couple of weeks. NPIs and associated information is easy to find too with a quick search on an online database.