TRICARE providers are required to submit a National Provider Identifier (NPI) with all electronic transactions, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NPI replaces all other identifiers, including Social Security number (SSN), tax identification number (TIN), Unique Physician Identification Number and Medicaid/Medicare provider identification number. Sole proprietors can avoid denied or deferred claims by understanding the common pitfalls related to NPI use and sole proprietorship.
 
According to the U.S. Department of Health & Human Services, a sole proprietorship is a business in which one person owns all of the assets of the business, and the sole proprietor is liable for all the debts of the business. Because sole proprietors are individuals, they must only apply for an Entity Type 1 Individual).
 
Sole proprietors are advised to check with PGBA, LLC (PGBA), any claims clearinghouses they use and the Internal Revenue Service to ensure the same NPI is being used by each entity. To contact PGBA, visit www.myTRICARE.com or call 1-800-403-3950.
 
For additional information, please visit the National Plan and Provider Enumeration System web site or call 1-800-465-3203.