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One of the benefits of the “electronic age” is the speed at which data can be exchanged and transactions completed. But in the health care industry, progress has been hampered by the lack of industry-wide standards and the lack of a single, unique identifier for each health care provider.
“Until now, any health plan that providers work with could assign them an ID number to use with that health plan,” explains Sherry McKenzie, chief of operational architecture and HIPAA electronic standards for TRICARE’s Information Management Division. “Not only did that mean providers had to keep track of multiple ID numbers, but it also made coordinating benefits and exchanging information across health plans more difficult and expensive.”
The new National Provider Identifier (NPI) program, called for in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), will ease that complexity. Slated to begin May 23, 2005, the program gives providers a two year window to apply for their unique NPI.
About NPI
The NPI is a 10-digit number that identifies a provider and will be required in all HIPAA-standard transactions. Each NPI will be assigned and managed by the National Plan and Provider Enumeration System (NPPES), a newly created federal registry, and will stay with the provider for life.
Providers who must participate include individuals physicians, dentists, nurses, pharmacists, physical therapists, etc.), as well as organizations (hospitals, clinics, HMOs, laboratories, pharmacies, etc.) that provide health care.
McKenzie notes that the NPI is an important step toward making the health care industry more efficient.
“We are behind some other industries in being able to use electronic transactions for various administrative purposes. For example, the financial industry does almost everything electronically. Now, having this standard national identifier will help us to implement transactions and move the health care industry further into the electronic world.”
A Practical Approach
The NPI number itself does not contain built-in “intelligence,” such as the type of provider or the state where the provider is located. The information required to apply for an NPI is similar to what state licensing boards require.
The NPI will make that basic information about providers more accessible and easily exchanged among health plans, however.
LCDR Stephanie Bardack of the DoD Patient Safety Office notes the practical nature of the NPI in today’s world.
“In the past, when providers would spend their entire career practicing in one state, their information would be provided to the state,” Bardack says. “Today, many providers move about the country, and billing systems are much more complicated than they once were. Having a single number to identify a provider across the country just makes sense.”
What You Need to Do
Providers have between May 23, 2005, and May 23, 2007, to apply for their NPI, either online or by completing a paper application. You are urged to apply as soon as possible.
Once you receive your NPI, it will be yours for life and will not need to be renewed. You will be required to inform the NPPES of any changes to your information (such as a change of address) within 30 days.
Under NPI guidelines, health plans may also choose to use the NPI in non-HIPAA transactions to replace previously assigned ID numbers.
To Learn More
If you want to learn more about the NPI, visit TRICARE’s Web site at www.tricare.osd.mil/hipaa/identifiers.html. If you have specific questions, e-mail TRICARE at hipaamail@tma.osd.mil.
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