MAY 16, 2005 CMS Tells Health Care Providers How To Obtain National Provider Identifiers For HIPAA Standard Transactions In this HIPAA Law Alert, we discuss the Centers for Medicare and Medicaid Services’ (“CMS”) recent announcement of the process for health care providers to obtain their National Provider Identifiers (“NPI”) for HIPAA standard transactions. What are National Provider Identifiers? HIPAA required the Department of Health and Human Services (“HHS”) to adopt a standard unique health identifier for health care providers. On January 23, 2004, HHS published its Final Rule on National Provider Identifiers, which requires all Covered Entities under HIPAA to begin using NPIs. In a nutshell, an NPI is a unique identifying number for every health care provider and it replaces health care provider identifiers that are in use today in HIPAA standard transactions. NPIs will eliminate the need for health care providers to use different identification numbers to identify themselves when conducting HIPAA standard transactions with multiple health plans. A health care provider’s NPI will be the same for all Medicare and non-Medicare HIPAA standard transactions. Obtaining the NPI does not, however, replace enrollment or credentialing procedures with any health plan, including Medicare. Who Must Use An NPI? All health care providers -- individuals (such as physicians, dentists, and pharmacists) and organizations (such as hospitals, nursing homes, pharmacies, and group practices) -- are eligible to apply for and receive an NPI. All health care providers who transmit health information electronically in connection with any of the HIPAA standard transactions are required by the NPI Final Rule to obtain NPIs (45 CFR Part 162 published in 69 Fed. Reg. 3434 on January 23, 2004). This requirement applies even if a business associate (such as a billing agency) is used to prepare the transactions. 1 of 3 Medicare, Medicaid, all private health plans and all health care clearinghouses must accept and use NPIs for all HIPAA standard transactions by the compliance date of May 23, 2007. (Small health plans have one extra year to comply.) However, these entities may require use of the NPI sooner. Each health plan, including Medicare, will notify health care providers when they are ready to begin accepting NPIs in standard transactions, such as claims submissions. The NPI will replace other identification numbers. Only the NPI will be used after the compliance date in standard transactions. How Can You Obtain An NPI? There are three ways health care providers can obtain an NPI: 1. Through a Web-based application process. The Web address will be https://nppes.cms.hhs.gov. The Web–based application will be available beginning May 23, 2005. o If all of the information filed using the Web-based application (such as Social Security number and employer EIN) is complete and accurate, CMS says that the NPI will be issued within minutes. 2. Use a paper application. However, paper applications may not be submitted until July 1, 2005. o CMS says that it cannot estimate the amount of time it will take to obtain an NPI through the paper application process since the time it will take to issue numbers will depend on workload and other factors. 3. An organization (such as a professional association or the health care provider’s employer) with the health care provider’s permission, will be able to submit the application in an electronic file for several health care providers at once. This process will be available in the fall of 2005. Where Can You Get More Information? CMS has issued a Medlearn Matters memorandum (Number: SE0528) that is available at http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0528. pdf The Medlearn Matters memorandum refers readers for additional information to the following resources: • http://www.cms.hhs.gov/hipaa/hipaa2 • Beginning May 23, 2005, by visiting https://nppes.cms.hhs.gov or calling the Enumerator at 1-800-465-3203 / TTY 1-800-692-2326. • And, for HIPAA information, by calling the HIPAA Hotline: 1-866-282-0659, or e-mailing [email protected] Nixon Peabody attorneys continue to be on the cutting edge of these and other HIPAA issues. If you have any questions about the Security Rule or HIPAA compliance, please contact any of the members of our Nixon Peabody HIPAA Task Force or your regular contact at the firm. 2 of 3 HIPAA Task Force Please feel free to call or e-mail your usual contact (emailname @nixonpeabody.com) or any of the attorneys in our HIPAA Task Force listed below. 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