The HIPAA NPI Final Rule, published in the Federal Register January 23, 2004, required adoption of the NPI as the standard unique identifier for health care providers. The compliance date for using NPIs in HIPAA standard electronic transactions was May 23, 2007. However, TRICARE invoked a 12-month contingency period similar to the CMS contingency planning guidance, which allowed TRICARE to process transactions with a legacy provider identifier, the NPI, or both until May 23, 2008. During this time TRICARE continued with ongoing collection and maintenance of provider NPIs, as well as testing of systems.
All entities that meet the definition of “health care provider” are eligible for NPIs. However, providers who are “covered entities” under HIPAA are required to obtain and use NPIs. A covered entity is a provider, health plan, or clearinghouse that conducts electronic health care transactions.
The NPI is a 10-digit, all-numeric identifier that must be used in all HIPAA standard electronic transactions to identify health care providers. NPIs do not contain intelligence about the provider. For enumeration purposes, there are two categories of health care providers. Entity Type 1 is for individuals, such as physicians, nurses, dentists, chiropractors, pharmacists, and physical therapists. Entity Type 2 is for organizations, such as hospitals, home health agencies, clinics, nursing homes, laboratories, and MTFs. The NPI is meant to be a lasting identifier and will not be replaced as a result of changes in a health care provider’s name, address, ownership, membership in health plans, or Healthcare Provider Taxonomy classification.
NPI enumeration of health care providers (i.e., assignment of NPIs to providers) and maintenance of NPI-associated data are being conducted through the National Plan and Provider Enumeration System (NPPES). The NPPES is the central system for identifying and uniquely enumerating health care providers at the national level. By now, TRICARE providers should have already obtained their NPIs. Any provider who has not obtained an NPI can do so through the NPPES Web-based application at the
NPPES web site or by submitting a
paper application. A copy of the application can also be obtained by request from the NPI Enumerator in one of the following ways:
