| 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.
Who needs a 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 a NPI. Standard transactions include transmissions to credit card
companies and billing agencies.
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.
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.
How to apply
Physicians, dentists, hospitals and other health care professionals and facilities
can apply for a NPI: www.cms.hhs.gov/nationalprovidentstand
Click here
for CMS' overview of the NPI initiative and a walk-through of the NPI application.
Registering NPIs with Horizon NJ Health
To ensure that claims submitted to us are paid correctly, NPIs need to be registered
with Horizon NJ Health.
Please notify Horizon NJ Health as soon as you receive your NPI Confirmation
Notice from CMS.
Submit NPIs to Horizon NJ Health:
* Fax: 1-609-583-3043
Please complete the Horizon NJ Health Collection
Form and fax it along with your NPI Certification Notice from CMS.
Next Steps
Once you have your NPI(s) you should:
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Inform your billing services, clearinghouses, practice management vendors
and other electronic trading partners of your NPI(s). |
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Confirm that you have correctly aligned your NPI(s) and validate that any
electronic trading partners have implemented your NPI(s) correctly. |
Questions?
Please send any questions to HNJH_NPI@horizonNJhealth.com.
A knowledgeable member of our NPI team will respond to your inquiry.
Using Your NPI
Horizon NJ Health will issue specific instructions regarding when NPI only can
be used on electronic transactions. Currently, if a NPI is submitted to Horizon
NJ Health, it will not be used for claims processing.
NPI Links
For more information about NPI:
For more information about taxonomy codes
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