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On Jan. 23, 2004, the Department of Health and Human Services (HHS) published the Health Insurance Portability and Accountability Act (HIPAA) Final Rule for the National Provider Identifier (NPI). This rule adopts the NPI as the standard unique identifier for health care providers. The rule became effective May 23, 2005, and affects both individual providers (e.g., physicians, nurse practitioners and pharmacists) and organizational providers (e.g., hospitals and pharmacies) who conduct HIPAA-standard electronic transactions.
The goal of the NPI is to simplify the administration of the health care system and enable efficient electronic transmission of health information. Next year, beginning May 23, 2007, providers must use the NPI when conducting HIPAA-standard electronic transactions. However, even before May, health plans may require the NPI on paper claim forms (CMS-1500 by February 2007, and UB-04 by March 2007).
Providers who are associated with TRICARE should begin now to obtain their NPI. Providers can apply through a Web-based application or by submitting a paper application that can be found at the National Plan and Provider Enumeration System Web site. A paper copy of the application can also be obtained by calling the NPI Enumerator at 1-800-465-3203 (TTY 1-800-692-2326).
TRICARE will be collecting providers’ NPIs and adding them to provider records in preparation for the mandatory May 2007 implementation. By collecting NPIs in advance of the deadline, TRICARE will be better prepared to accept the NPI in HIPAA-standard electronic transactions, such as electronic claims or electronic eligibility queries.
In the coming months, your regional TRICARE contractor, Humana Military, will provide more information about how, where and when to submit your NPI, as well as other information related to NPI implementation.
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