|
Providers RSS feed 
|
National Provider Identification |
NPI Questions
Print the National Provider Identification (NPI) Form indvidual or group, complete the form with current information and send it via one of the following means: address or fax.
What is NPI?
- The NPI is one of the required HIPAA identifiers to be used in "standard" electronic health care transactions
- unique and permanent healthcare provider identifier
- 10 numeric positions; the 10th digit as a check sum Required in most
- X12 transactions and NCPDP Pharmacy transactions
- Inactivated only upon death or dissolution of the health care provider
- Replaces existing legacy provider numbers used for billing, servicing, referring, etc. including:
- UPIN
- Medicaid Provider Number
- Medicare Provider Number
- Blue Cross and Blue Shield Numbers
- Other internal proprietary health plan provider numbers
Back to top
What is it for?
- Current federal legislation requires that the National Provider Identifier (NPI) be utilized in all HIPAA "standard" EDI transactions beginning May 23, 2007, e.g., X12 837 claims transactions will need to carry NPI in order for providers to be paid
- Required whenever the HIPAA Implementation Guides require a provider identifier in a standard transaction
- Legacy identifiers cannot be used after May 23, 2007
- Reference: 45 CFR Part 162 - HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule
- TennCare policy will require the use of NPI on all paper transactions (UB-04, CMS 1500, Dental) and will follow the proposed Medicare implementation timeline.
Back to top
Who needs an NPI?
- Health Care Providers
- Individuals only have ONE NPI
- Organizational options are:
- One NPI for all
- One NPI per location
- One NPI per taxonomy per location
- One NPI per taxonomy across locations
- Other combinations up to the provider
Back to top
How is an NPI obtained?
- National Plan and Provider Enumeration System (NPPES)
- Uniquely identifies providers
- Validates some data to prevent duplicates
- Assigns NPI
Back to top
What do TennCare health care providers need to do?
- Obtain your NPI NOW.
- All new TennCare enrollments effective January 2, 2007, will be required to have their NPI.
- If you are currently enrolled in one or more of the following TennCare managed care health plans, submit your NPI information directly to the health plan(s) per procedures established by those organizations. TennCare will obtain your NPI information from them.
- Better Health Plan Inc. (Unison)
- Doral Dental
- First Health
- Heritage National Health Plan of TN (AmeriChoice - East)
- Memphis Managed Care Corp. (TLC)
- UAHC (Omnicare Health Plan)
- Preferred Health Partnership
- Premier Behavioral Sys of TN
- TennCare Select
- Tennessee Behavioral Health Inc.
- Windsor Health Plan of TN, Inc.
- Volunteer State Health Plan (BlueCare)
- TennCare will begin collecting NPIs from health care providers who are not enrolled in one or more of the TennCare managed care health plans on January 2, 2007.
Back to top
NPI Resources
Background
CMS NPI Overview
CMS Frequently Asked Questions
Applying for an NPI
National Plan & Provider Enumeration System (NPPES)
Apply for an NPI via NPPES (FOX Systems Inc.)
NPI Enumeration Reports
Medicare Links
Medicare NPI Implementation
Medicare Learning Network
Medicare NPI MLN Matters Articles
WEDI Links
WEDI (Workgroup for Electronic Data Interchange)
WEDI NPI Outreach Initiative (NPIOI)
WEDI NPI Whitepapers
Technical Reference
X12 Implementation Guides
ASC X12 IG Interpretations Portal
Provider Taxonomy Lookup Table
Legal Issues
Final rule for NPI
Can a solo practice be a Type 2 provider?
NPI Privacy Information
CMS Covered Entity Decision Support Tool
Other Sites of Interes
National Provider Identifier (NPI) Compliance Services (FOX Systems)
NPI Sub-part Decision Tree White Paper
UPIN Registry (NHIC)
Claredi - NPI Resources
CMS NPI Electronic File Interchange ("Batch Enumeration")
EFI Certification Statement
Back to top
Contact Us
Mail: Provider Services
Attn: NPI Collection
310 Great Circle Rd
Nashville, TN 37243
Fax # in the Nashville area 615-248-4386
Fax # outside of the Nashville area 866-456-8059
Back to top
|
