NPI Notification
Hometown Health is working with the federal government and providers with National Provider Identifier (NPI) requirements. By May 23rd, 2007, all health care providers who utilize HIPAA standard electronic transactions must have an NPI. Providers who do not utilize HIPAA standard electronic transactions may have an NPI. Hometown Health and all other large health plans and payers must have the capability to use the NPI to identify providers in standard electronic transactions after May 23rd, 2007.
The National Provider Identifier (NPI) is a unique identification number for use in standard health care transactions. The NPI is a new number that will be issued to health care providers and covered entities that transmit electronic transactions (e.g., electronic claims and eligibility verification) through the National Plan & Provider Enumeration System (NPPES). As of May 2005, the National Plan & Provider Enumeration System, an entity established by the federal government, began issuing NPIs to providers that apply and qualify for one.
Again, this identifier, which fulfills a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), must be used by health plans and health care clearinghouses in HIPAA standard electronic transactions by May 23, 2007. NPIs will replace other provider identifiers previously used by health care providers (and assigned by payers). NPIs will not replace the tax identification number (TIN) on the HIPAA electronic transactions when used for tax reporting. This applies only to the 837 electronic claim.
Even if you don't send electronic transactions from your practice, an NPI may be needed to identify you in other situations, such as when another provider wants to refer a patient to you, a pharmacy needs to bill for drugs you prescribed, a hospital needs to bill for a patient you treated or admitted, or a lab needs to bill for services you ordered. You will also need an NPI if you bill Medicare on paper forms. Hometown Health continues to work with community providers on issues and concerns surrounding NPI requirements. If you have any questions, please call us at 775-982-3112. We look forward to working with all providers during this transition and wish to emphasize the importance of electronic claims submission and NPI compliance.
For your benefit, we have included below information on how a health care provider can apply for an NPI and how you would submit this information to Hometown Health. The Centers for Medicare & Medicaid Services (CMS) has contracted with the National Plan & Provider Enumeration System (NPPES) to administer the assignment of NPIs and deal with health plans and providers on issues concerning unique identification. There are only three ways a health care provider can apply for an NPI:
- Complete the application online at https://nppes.cms.hhs.gov. Estimated time to complete the NPI application is 20 minutes.
- Complete a paper copy by downloading it from https://nppes.cms.hhs.gov, or by calling 1-800-465-3203 to request a copy.
- With the provider's permission, an organization may submit the application in an electronic file on behalf of the provider.
If you have already obtained your NPI you may complete the attached "Provider Change Form" and fax to Hometown Health (one form per NPI) at 775-982-3751 to update your provider information.
