NATIONAL
PROVIDER IDENTIFIERS
Dentists will no longer have to keep track
of multiple numbers to identify themselves with one
or more dental or medical plans. While there is no
rush, dentists will be able to use the Internet to
apply for a unique National Provider Identifier (NPI),
beginning May 23, 2005. HIPAA’s National Provider
Identifier. THIS MUST BE COMPLETED BY NO LATER THAN
MAY 2007.
Rule requires all HIPAA-covered entities to use the
NPI to identify healthcare providers in HIPAA standard
transactions by May 23, 2007. Since HIPAA standard
transactions are electronic, the NPI is not required
by HIPAA on paper claims. Certain carriers, however,
may require an NPI on paper claims, so all providers
are encouraged to apply for one. The NPI will consist
of ten digits, and it will replace all payer-specific
provider identification numbers (e.g., BCBS provider
numbers, Medicare UPINs, Medicaid ID numbers, CHAMPUS
ID numbers, etc.). Once the NPI compliance deadline
takes effect (May 23, 2007), dental plans (and medical
plans) will not be allowed to require a separate payer
specific provider number.
The NPI will not replace tax identification numbers.
Providers will still need to submit their Social Security,
Number or Tax Identification Number (TIN) because
they are needed to report 1099 payments to the IRS.
Providers that are not HIPAA-covered entities may
request an NPI as well but are not required by federal
law to do so. There are three ways that providers
can apply for their NPI. The first option is to use
an interactive application available on the Internet.
The web-based application will be available beginning
May 23, 2005 at www.nppes.cms.hhs.gov.
If you have difficulty accessing this site, watch
for a Web News update at www.dental-ins-solutions.com.)
Your second option is to submit a paper application.
Paper applications will be available July 1, 2005
and can be obtained by calling 800-465-3203. (You
may also be able to print one from the CMS website
listed above.)
The third option is to allow an organization (such
as a group practice) to file on your behalf. This
option is expected to be available in September 2005.
NPI applications will require the provider’s
name, practice location(s), mailing address, phone
number, Social Security number for individuals or
TIN for organizations, birthdate, state and country
of birth, gender, and state license number. According
to CMS, each health plan is responsible to notify
providers when it is capable of accepting the NPI
on standard transactions before May 23, 2007.
We do not expect to see many carriers requiring
them until May 2007. Additional information about
national provider identifiers can be obtained by calling
the CMS HIPAA Hotline at 866- 282-0659. Questions
can also be emailed to ASKHIPAA@cms.hhs.gov
