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Members Icon National Provider Identifier (NPI)
What NPI Is and How It Works

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:
  1. Inform your billing services, clearinghouses, practice management vendors and other electronic trading partners of your NPI(s).
  2. 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