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 National Provider Identifier (NPI)
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What NPI Is and How It Works
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The mandated use of National Provider Identifiers (NPIs) for electronic transactions is less than one year away. Will you be ready on the effective date, May 23, 2007?
What is NPI?
The National Provider Identifier system is a mandate of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Effective May 23, 2007, physicians, dentists, hospitals and other health care professionals who submit claims electronically will no longer need to keep track of and use multiple ID numbers for multiple insurers. Instead, you will use an NPI supplied by the Centers for Medicare and Medicaid Services (CMS).
The NPI is a 10-position numeric identifier that contains no identifying information such as the provider type or location.
Now you can also easily register your NPI(s) with us by using our online registrar.
Just sign into our secure Physician Online Services. Once in Online Services, click on the "Submit NPI" link to input your information and scanned copies of your CMS Notifications.
To sign into Physician Online Services, click here.
If you have not yet registered for Physician Online Services, click here.
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Who needs an NPI?
All physicians, dentists, hospitals and other health care professionals who transmit health information in the standard electronic form in connection with HIPAA standard transactions (known as "covered health care providers") must obtain an NPI. Standard transactions include transmissions to credit card companies and billing agencies.
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How are NPIs assigned?
CMS has contracted with a vendor, Fox Systems, to assign NPIs. Two types of NPIs are assigned:
- Entity Type 1 - issued to health care professionals including physicians, dentists, nurses, chiropractors, pharmacists and physical therapists.
- Entity Type 2 - issued to health care organizations or institutions. This includes hospitals, home health agencies, nursing homes, clinical laboratories, ambulance companies, group practices, durable medical equipment suppliers and pharmacies.
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Determine how many NPIs are needed
More than one NPI may be needed, depending on several factors such as multiple locations or specialties. Please review how you submit claims for services today and determine how you want to submit claims in the future.
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How to apply
Physicians, dentists, hospitals and other health care professionals and facilities can apply for an NPI:
www.cms.hhs.gov/nationalprovidentstand
Click here for CMS' overview of the NPI initiative and a walk-through of the NPI application:
www.cms.hhs.gov/apps/npi/npiviewlet.asp
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Registering NPIs with Horizon BCBSNJ
To ensure that claims submitted to us are paid correctly, NPIs need to be registered with Horizon BCBSNJ.
Please notify Horizon BCBSNJ as soon as you receive your NPI confirmation from CMS.
Now you can also easily register your NPI(s) with us by using our online registrar.
Just sign into our secure Physician Online Services. Once in Online Services, click on the "Submit NPI" link to input your information and scanned copies of your CMS Notifications.
To sign into Physician Online Services, click here.
If you have not yet registered for Physician Online Services, click here.
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Next Steps
Once you have your NPI(s) you should:
- Inform your billing services, clearinghouses, practice management vendors and other electronic trading partners of your NPI(s).
- Confirm that you have correctly aligned your NPI(s) and validate that any electronic trading partners have implemented your NPI(s) correctly.
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Please Note
Horizon BCBSNJ will issue specific instructions regarding when NPI only can be used on electronic transactions. Currently, if an NPI is submitted to Horizon BCBSNJ, it will not be used for claims processing.
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NPI Links
For more information about NPI:
For more information about taxonomy codes:
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