Wednesday, May 4, 2016

What is a National Provider Identifier (NPI)?

key words:  hospital practice, employment, NPI, HIPAA, insurance, Medicare and Medicaid (CMS), LIP

The National Provider Identifier (NPI) is a standard through the HIPAA (Health Insurance Portability and Accountability Act) Administrative Simplification Standard.

Remember the goal of HIPAA was (and is) to standardize and simplify the insurance processing system.

NPIs are issued to U.S. healthcare practitioners by the Centers for Medicare and Medicaid Services (CMS).  The CMS website explains that, "The NPI is a unique identification number for covered health care providers [who, along with all plans or companies who provide health care insurance] must use the NPIs in the administrative and financial transactions adopted under HIPAA.  The NPI is a 10-position, intelligence-free numeric identifier."

While an NPI is required to bill insurance, every LIP should have an NPI, even if you never plan to bill or take insurance.  It costs nothing and is an easy registration process.

You cannot work at a hospital without an NPI.  It is a standard requirement as part of employee paperwork.  To register for an NPI, go to the NPPES (National Plan & Provider Enumeration System) site.  The site has references to the related standard in the federal HIPAA rule.

For more on these terms, see related posts:


U.S. Public Law, the Patient Protection and Affordable Care Act.  Officially:  Public Law 111–148 111th Congress.  Currently dated March 23rd, 2010.  Length of document on pdf:  906 pages.

The implementation of this federal law is often called:  “The Affordable Healthcare Act (ACA)” or “ObamaCare”

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