The National Provider Identifier (NPI) is an Administrative Simplification Standard under the Health Insurance Portability and Accountability Act (HIPAA). For covered health care facilities, the NPI is a distinctive identification number. In the administrative and financial transactions implemented under HIPAA, covered health care services and all health programs and health care clearinghouses must use the NPIs.
It is a 10 digit number which is an intelligence-free numeric code. Intelligence free means that it does not hold any other healthcare service provider information, such as the number of the driving license, the state in which it lives, or any other information. The NPI in the HIPAA standards transactions must be used instead of legacy provider identifiers.
When doing business with various health insurers, the NPI would remove the need for health care providers to use separate identification numbers. The adoption and use of NPIs is now mandated by many government programs, including Medicare, Medicaid, and private health insurance plans, and all health care clearinghouses.
NPI numbers have two types:
Type 1 for individuals- this is where you can look up doctors, Physicians, chiropractors, dentists, Nurse practitioners, and others.
Type 2 for organizations- that provides services or health care supplies such as hospitals, nursing homes, laboratories, pharmacies, and home health care agencies.
HIPAA Rules for NPI
In the administrative and financial transactions implemented under HIPAA, covered healthcare providers, and all insurance plans and healthcare clearinghouses must use NPIs.
HIPAA rules and regulations state that covered insurers must also share their NPI with other providers, health plans, clearinghouses, and any agency that may need it for billing purposes.
Is the NPI required for all healthcare providers?
Yes, it is mandatory that all healthcare providers must obtain and use an NPI. Below is the list of healthcare providers that need NPI.
- Physical Therapists
• Group Practices
• Health Maintenance Organizations (HMOs)
• Home Health Agencies (HHAs)
• Nursing Homes
• Residential Treatment Centers
• Suppliers of Durable Medical
• Equipment (DME).