The National Provider Identifier usually refers to a 10-digit numeric identifier that must be utilized on claim forms after submitting it to payors by individual and agency health care providers who acquire the term of a "covered entity" under the authority of HIPAA which started on the day of May 23, 2008. The procedure of application was started in May 2005.
CMS issued data related to the development of contingency policies on April 2007 that would permit providers extra time to apply for NPIs and permit providers or insurers extra time to make adjustments essential to accept NPIs on claim forms. CMS won’t take any sort of action against entities that would breach HIPAA. Entire contingency policies were ended up on May 23, 2008. CMS will then take strict action against those who aren’t in agreement with the HIPAA NPI regulations.
CMS was recommending during the time of May 2005 to May 2008 transition that providers should sustain to use both their regular identifiers with the NPI, once they get it, until and unless they hear distinctively from their individual payers. This practice was known as "dual identifier use."
For completing the application online, go to the National Plan and Provider Enumeration system Web site. You can also call on 800/465-3203 for paper application.
Requirement of NPI
The NPI must be utilized on claims forms by entire health care providers in case to be paid who acquire the term of "covered entity" after May 23, 2008. According to the Health Insurance Portability and Accountability Act mandates, its utilization will further modify the procedures of electronic claims already in place. This will also makes the claims submission simpler for providers, given that separate insurer-specific numbers will no longer be important. CMS has asserted that NPI’s utilization will surely improve efficiency and decrease costs.
Does NPI is used for Medicare Claims only?
The entire legacy or billing numbers for all public and private health insurance plans would be finally replaced by NPI.
Why my claims were getting rejected after using NPI on 2008?
Firstly, look at the codes on the remittance advice you get. Guidance on some of the most common remittance advice codes had been released by Medicare which you may get for Medicare claims and a description for what these codes mean.
On the second had, make sure that the data on your Medicare enrollment application get matched with the data you submitted on NPI application. If there are any differences founded between these two applications, the claims might have to face rejection as they can’t be suitably matched through the NPI crosswalk.
If the Medicare enrollment information and NPI information do not match, then what to do?
The updates can be completed on your NPI application online and in a relatively timely manner; it would be recommended to update the NPI data to match with your Medicare enrollment application.
Will the group practice also be needed for NPI?
The group practice will be required to acquire an NPI in addition to the individual physical therapists working in the practice.
Do I require both the individual NPI and an NPI for practice if I’ve a solo practice, but have incorporated my practice?
The corporation and the individual therapist should each have an NPI in this situation. Your state physical therapy license number should be visible on the individual application. The corporate application should involve the number linked with the corporate entity. It is unimportant to mention state license number on the application for the corporate NPI. You must apply for each NPI individually and separately, you’ll be inquired to make a profile for each type of application on the NPPES Web site.
Is it compulsory to apply for an NPI if I work as a physical therapist in a skilled nursing facility and do not bill separately for my services?
All health care practitioners can qualify to apply for an NPI in accordance to CMS, even if your services, as the rendering practitioner, are billed by the facility and not individually.
Is there any need to apply for an NPI if I’m working as a physical therapist assistant?
Physical therapist assistants are qualified to apply for an NPI. Your facility's administration might need you to get your NPI for tracking purposes, but that is not compulsory for health care providers who aren’t "covered entities" under the regulations of HIPAA.
When I’ll get to know that this is the right time to use only NPI?
Effective on the day of May 23, 2008, you might only use the NPI on the claim form.
How long does the application procedure take if I want to apply for a Medicare supplier number and notice that application now needs me to have an NPI?
Once you are done in assembling the required documents, the online procedure takes only 20-30 minutes. If you’re applying by mail, factor in turnaround time for processing and mailing.
Where can I get required data about the claim forms that accommodate the NPI?
The required data on the new claim forms for use after the May 23, 2007, is available at the CMS Web site.
Does CMS give outreach to providers on the NPI?
For this information, do visit the CMS Web site for more data. This resource now covers training package, a power point presentation, and several most common asked queries.