NPI Frequently Asked Questions

Here are answers to some of the questions we're asked most often. If you don't find the answers you need here, please check our tips on using your health program here, contact our customer service representatives here, or call 1-800-440-1561, Monday through Friday, between 8 a.m. and 6 p.m. Pacific Time.

What is a National Provider Identifier (NPI)?

An NPI is a random, unique 10-digit numeric identifier assigned by the federal government to health care providers and organizations defined as covered entities under HIPAA. The NPI will be a permanent identifier assigned for life.

For more information go to: http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM4023.pdf

Who should obtain an NPI?

All organizational and individual health care providers who are HIPAA-covered entities must obtain an NPI to identify themselves in HIPAA standard transactions.

For more information go to:
http://www.cms.hhs.gov/NationalProvIdentStand/downloads/npi_fs_geninfo_010906.pdf

How can a health care provider apply for an NPI?

A health care provider may apply for an NPI in one of three ways:

Through a web-based application process. The web address is https://nppes.cms.hhs.gov.
Prepare and send a paper application form to the Enumerator (Fox Systems). A copy of the application form, which includes the Enumerator's mailing address, will be available only upon request through the NPI Enumerator.
The Enumerator's phone number is 1-800-465-3203 or TTY 1-800-692-2326.
E-mail: customerservice@npienumerator.com
Mail: NPI Enumerator, P.O. Box 6059 Fargo , ND 58108-6059
With the permission of the health care provider, an organization may submit a health care provider's application in an electronic file. CHP is not engaging in bulk enumeration on behalf of providers.

What are the advantages of the NPI?

Simpler electronic transmission of HIPAA standard transactions;
Standard unique health identifiers for all health care providers that will not change in the event of practice relocation and/or changes in specialty;
More efficient coordination of benefits transactions;
An easier process for health plans to track transactions and avoid duplication.

http://www.cms.hhs.gov/NationalProvIdentStand/downloads/npi_fs_geninfo_010906.pdf

Will Community Health Plan require providers to show their NPIs on all HIPAA-compliant forms, beginning May 23, 2007?

No. Community Health Plan will implement its contingency plan which includes acceptance of legacy provider identifiers during the 12-month contingency period established by CMS. Community Health Plan will monitor providers who continue to submit transactions with legacy provider identifiers during the contingency period and will work with them to bring them into compliance with NPI regulations.

Community Health Plan encourages providers who have not yet done so to obtain and uses NPIs in their HIPAA transactions.

How do I determine if my organization needs to subpart?

It is the provider/facility decision to subpart or not. The decision should be based on an organization's business need.

For guidance from CMS on sub-parts go to:

http://www.cms.hhs.gov/NationalProvIdentStand/downloads/npi_fs_subparts_032106.pdf
http://www.cms.hhs.gov/apps/npi/npiviewlet.asp

CMS has also published expectations related to Medicare subparts:

http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Medsubparts01252006.pdf

What are Community Health Plan's plans for compliance?

We are utilizing a project management approach to coordinate business and system impacts of the NPI. We will transition to HIPAA compliance by following a dual-use strategy, which means we will accept both NPIs and legacy identifiers during the contingency period established by CMS.

How will the plan communicate NPI readiness to their providers?

Community Health Plan plans on publishing NPI status updates in quarterly provider newsletters as well as providing NPI status and detailed information on the Provider Web Site. Other methods such as direct mailings may also be used for sharing information or requesting action from providers related to NPI.

How and when should I report my NPI to the health plan?

Community Health Plan is already collecting NPIs from providers. The provider applications used have a place for the NPI which are entered into the Adaptis Database upon receipt.

Existing providers do not have to complete a new application to supply us the NPI number.

You may contact your Provider Representative directly to update your NPI.

What will happen to claims transactions without NPIs?

Community Health Plan will accept electronic and paper claims with legacy provider identifiers as well as NPI numbers during the contingency period established by CMS. Electronic claims with no NPI will not be rejected by Availity (formerly THIN), which is Community Health Plan's clearinghouse, during the contingency period.

Community Health Plan encourages providers who have not yet done so to obtain and use NPIs in your HIPAA transactions.

Will the NPI replace other numbers I use?

Will you require providers to use their NPI on paper form submissions?

Community Health Plan will require NPI numbers on all paper claims.

Will you use the NPI to determine how to pay claims and to whom?

NPIs will be used to help identify the appropriate provider information in CHPW systems. However, we will continue to use the billing provider's tax ID number to ensure that payment is reported appropriately to the IRS.

Will you send the legacy identifier or NPI or both on the 835 transaction?

Community Health Plan will follow the guidelines published by CMS which require the reporting of NPI on all HIPPA electronic transactions.
Reference: http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM4023.pdf

How will you test NPI submissions with health care providers?

Community Health Plan is engaged in internal testing of claims transactions using the NPI and will continue to do so to ensure a smooth transition.

Will users be able to search the on-line provider directories using the NPI?

Our decision is pending publication of the CMS data dissemination notice. The notice will provide specific details on whether or not NPI is permitted in provider directories.

Where can I go for additional help and information?

CMS Link regarding NPI
http://www.cms.hhs.gov/NationalProvIdentStand/06_implementation.asp

WEDI National Provider Identifier Outreach Initiative (NPIOI)
http://www.wedi.org/npioi/public/articles/index.cfm?fuseaction=link

Up-to-date information regarding the NPI is available on the
NPPES web site at https://nppes.cms.hhs.gov/NPPES.

Is there a designated contact for NPI implementation issues?

The contact for NPI implementation is your Provider Relations Coordinator.
If you are currently sending you NPI information electronically with your claims, we are capturing that information and storing it.
If you want to begin sending your NPI information electronically you can do so with you electronic claims. Please be sure to check with your software vender on the placement of the NPI information.
If you have your NPI information and just want to pass it on. Please call your Provider Relations Coordinator or contact the Provider Relations Department at 206-521-8830