The Department of Health and Human Services (DHHS) adopted the Health Insurance Portability and Accountability Act (HIPAA) National Provider Identifier (NPI) final rule as the standard unique identifier for health care providers on Jan. 23, 2004. This 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. Beginning May 23, 2007, providers must use the NPI when conducting 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.

Each individual health care provider will be assigned only one NPI that will be used for medical services provided under every medical plan or program (e.g., a civilian health plan like Kaiser or a military health plan like TRICARE).

Health care organizations may have multiple NPIs if they choose; for example, a hospital would be assigned an NPI and their outpatient departments, surgical centers and laboratories also may be assigned separate NPIs.

The NPI is meant to be a lasting identifier and would not usually change as a result of changes in a health care provider’s name, address, ownership, membership in health plans or Healthcare Provider Taxonomy classification.

You may submit an electronic application for your NPI, via the Centers for Medicare and Medicaid Services Web Site. CMS will accept paper NPI applications from those organizations that have participated in their “pilot” test. CMS anticipates acceptance of paper applications for NPIs from all providers beginning July 1, 2005. More detailed information on the application process and where to submit applications can be found on the CMS Web Site.

The TRICARE Management Activity (TMA) will be implementing new requirements to ensure compliance by both contractors and providers. Once you obtain your NPIs, you will need to submit your NPIs to TRICARE in order to conduct HIPAA standard electronic transactions, such as electronic claims or electronic eligibility queries. More details regarding where to submit your NPI will be communicated as they are developed.

Where Can You Find More Information?

The TRICARE HIPAA Office of Electronic Standards has made several documents available online to provide additional information to providers. Questions may be sent to the TMA HIPAA Office of Electronic Standards via e-mail at hipaamail@tma.osd.mil.

On Sept. 1, 2005, TRICARE’s Extended Care Health Option (ECHO) will replace the existing TRICARE Program for Persons with Disabilities (PFPWD). This new program will continue to deliver financial assistance to active duty family member beneficiaries who have a qualifying condition as defined by the law. It will also continue to offer an integrated set of services and supplies that supplement the basic TRICARE program options—TRICARE Prime, TRICARE Standard and TRICARE Extra.

There are many similarities between PFPWD and ECHO, as well as differences. For example, the government’s cost-share has increased from $1,000 to $2,500 per month, and home health and respite care benefits have expanded.

• Moderate or severe mental retardation
• A serious physical disability

• An extraordinary physical or psychological condition of such complexity that the beneficiary is homebound

Details to Come

Look for additional information about the new TRICARE ECHO Program. Current PFPWD participants will be receiving letters explaining the change from PFPWD to ECHO.

If you believe that one of your patients has a condition that may qualify for services under TRICARE ECHO, contact Humana Military at 1-800-444-5445 or advise them to visit the TMA site for additional information at www.tricare.osd.mil/echo/default.cfm.

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