Thursday, October 20, 2005

Another Layer of Bureaucracy....

HIPAA National Provider Identifier

We don't have enough numbers as it is, so on January 23, 2004 our Department of Health & Human Services published a final rule stating that all providers will need to use a new National Provider Identifier (NPI) to conduct HIPAA standard transactions (i.e. electronic claims, eligibility inquiries, claims status inquiries, etc...) by May 23, 2007. Wow! And I thought I already had useful, well-earned national numbers with my UPIN and PIN from the Centers for Medicare and Medicaid Services [which, by the way, took a year to obtain, because they lost my application]. How about all those other provider numbers I've been given by each insurance company to identify me within their network. No. Those aren't enough! Now we will have the mother of all numbers -- the NPI. And, I promise, no confusion whatsoever. This 10 digit number will supersede all others when conducting standard transactions with health plans.

Now when I call the insurance plans, oftentimes they don't know their left hand from their right. So, apparently this one number is the remedy to all problems. It will single-handedly improve the efficiency and effectiveness with which electronic claims are processed, because obviously the previous numbers didn't. So it makes absolute sense that the solution is replacing one number with another number.

Most payers must be able to accept NPIs by May 23, 2007. Smaller health plans may have until May 23, 2008 to get on board, because apparently they determined that if you're small, you need a little extra time. But remember:

Do not begin using your NPI until a plan notifies you it is ready to accept it.


I have a feeling that what we're going to end up with, is insurance plans using both the NPI and their own internal number to identify providers. This will not be seemlessly implemented. And probably will initially result in more confusion, and delayed claims, than help -- the same way that the ultra-modern new Denver International Airport baggage handling system flopped.

Nonetheless, being the rule-abiding citizen that I am, I have applied for my very own NPI, and you may too if you are a provider by going to:

Apply Online for an NPI

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