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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 final rule goes into effect May 23, 2008, 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. Beginning May 23, 2008, providers should comply by submitting the approppriate NPI on all HIPAA-standard electronic transactions.
Providers who are associated with TRICARE can obtain their NPIs through a Web-based application or by submitting a paper application that can be found at the National Plan & Provider Enumation 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).
Once you have obtained your NPIs, it is equally important that you contact your practice management system vendor and electronic claims clearinghouse or billing service in order to determine the steps that need to be taken in order to transmit your NPIs on your electronic TRICARE claims.
Humana Military has been supporting a “dual-use period” since April 2006 that allows providers to send their NPIs along with their old legacy identifiers on electronic claims. (We will continue to require and use the legacy identifiers to process your claims until the mandated compliance date.) Compliance date begins May 23, 2008.
Individual providers (Type 1) and Organizational providers (Type 2) can post their NPIs with us through Online Provider Services by clicking on the link NPI Registration and Maintenance(Business Offices). You need to be sure that all of your NPIs have been registered with us. PGBA also has a Provider NPI "Update and Maintain" option on www.mytricare.com.
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