Tuesday, December 8, 2009

Is a health care provider required to obtain a National Provider Identifier (NPI)?

Question: Is a health care provider required to obtain a National Provider Identifier (NPI)?

Answer : Yes. Under the NPI Final Rule (69 FR 3434), health care providers who are covered entity under HIPAA were required to obtain an NPI and to use it to identify itself as a health care provider in HIPAA transactions as of May 23, 2007. Small health plans were required to use the NPI since May 23, 2008. A health care provider is a covered entity if it transmits any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard. For example, any health care provider (individual or organization) who sends electronic health care claims to a health plan(s),is a covered provider and must obtain an NPI. Health care providers who are not covered providers may elect to apply for NPIs, but are not required to do so. For the latest information regarding NPI issues for health care providers, visit this website: www.cms.hhs.gov/NationalProvIdentStand/
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