Here comes the NPI

April 8, 2005

CMS will soon start issuing National Provider Identifiers to replace current PINs, UPINs, and most other IDs.

If you're tired of keeping track of a multitude of identification numbers, relief is on the way-though it will take a while to get here. Starting in late May, you can apply for your National Provider Identifier, or NPI. These unique 10-digit ID numbers, to be issued by CMS, will be assigned to all physicians, medical groups, hospitals, labs, and nursing homes-in short, all healthcare providers.

Mandated by HIPAA under its Administrative Simplification provisions, the NPI is part of the government's effort to standardize healthcare transactions. Gov-ernment agencies will be able to use NPIs to identify healthcare providers, and to investigate cases of possible fraud and abuse.

Once NPIs are in general use, you'll no longer have to keep track of multiple ID numbers when dealing with different health plans. NPIs will eventually replace current PINs, UPINs, and other ID numbers for all transactions with health plans, Medicare, Medicaid, TRICARE (formerly CHAMPUS), and electronic claims clearinghouses.

You can apply for your NPI online or download application forms from the CMS Web site: http://www.cms.hhs.gov/forms. For those without Internet access, paper applications will be available by mail later this summer from a CMS contractor.

The application will ask for your birth date, Social Security number, office address, specialty, and state license number. You'll be required to update that data within 30 days of any change. Once assigned, your NPI will never expire or change, even if you move to another state. When you retire, or die, your number will be deactivated-not reassigned to another physician.

Once health plans begin accepting NPIs, you can start using yours on claim forms, although you may still need to use your old ID numbers as well until the plans switch over completely. Your NPI won't replace your DEA or state license number, however, and your Taxpayer Identifying Number, or TIN, may still be required for tax purposes.

Despite the May launch date for NPIs, there's no rush to apply. According to Rosemarie Nelson, a Syracuse consultant on medical practice information systems, "Doctors should be informed about NPIs, but they don't need do anything right now, since health plans aren't using them yet."

There may even be a reason to wait: By the end of this year, CMS hopes to arrange for state medical societies and other professional organizations to apply for NPIs on behalf of their members.

Why think about your NPI now? One reason is that if you're considering buying a new practice management or EHR system for your office, you'll need to make sure it can accommodate an NPI.