Transcript NPI Type 1 Training Presentation Template

National Provider Identifier Type 1
Workforce Training
Month Day, Year
The NPI will become the standard, unique
identifier for health care providers in HIPAA
Transactions
Purpose
• This training presentation is being
delivered to educate workforce
members on
– National Provider Identifier Requirement
– How to Obtain an NPI
– How to Report NPI to Facility/Division
– NPI Resources Available
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National Provider Identifier
Requirement
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Background
• The NPI is a HIPAA Administrative
Simplification Standard
– Transactions and Code Sets
– Security
– Privacy
– Identifiers
• Unique Employer Identifier
• Unique Health Care Provider Identifier (NPI)
• Unique Health Plan Identifier – Proposed rule
pending
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NPI Final Rule
• Published January 23, 2004
• Requires the use of the NPI in standard
transactions to identify health care providers
standard transactions no later than 5/23/07
• Replaces the use of proprietary and legacy
provider identifiers in standard transactions
–
Unique Physician Identification Number (UPIN)
–
Medicaid ID
–
Medicare ID
–
BCBS, Aetna, etc. IDs
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NPI Final Rule – cont’d
• Placed requirements on HIPAA covered
entities
– Health plans (e.g., Medicare, NC Medicaid,
BCBS)
– Health care clearinghouses
– Health care providers conducting HIPAA
standard transactions
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•
•
DMH/DD/SAS facilities
DPH State Lab and CDSAs
OES Schools
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Who Must Get an NPI?
• All health care providers who conduct any
of the HIPAA standard transactions
– Individuals – NPI Type 1
• These individuals furnish health care services that are
billed using HIPAA standard electronic transactions or
may initiate and / or receive referrals. This includes:
– DHHS Workforce Members
– Private Providers
– Organizations – NPI Type 2
– Organization “Subparts” – NPI Type 2
• Components of organizations that conduct transactions
separately from the rest of the organization
• Note – all “health care providers” as
defined by 160.103 are eligible for NPI
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Who Must Get an NPI in This
Facility?
• List Provider Types Here
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What is an NPI?
• 10 digit number
• All numeric
• Never changes
– Good for the life of the provider
– May be deactivated/reactivated
• Does not itself convey information
about the provider
– Legacy provider numbers may have
“intelligence” that describes the provider
type, specialty, and location
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Who Assigns NPIs?
• NPI Enumerator – HHS contracted
with Fox Systems, Inc.
– Process applications and assigns NPIs
– Maintains NPI data in the National Plan
and Provider Enumeration System
(NPPES)
– Furnishes NPI information upon request
and in accordance with established
guidelines
• Privacy Policy available at
https://nppes.cms.hhs.gov/
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DHHS Approach to Workforce
Enumeration
• DHHS HIPAA Oversight Committee
Recommendation
– DHHS not assume the responsibility to
submit NPI applications for workforce
members
– Memo sent to DHHS Division Directors
April 2006
(http://hipaa.dhhs.state.nc.us/hipaa2002/i
dentifiers/identifiers.html)
• DHHS Policy under development to
support decision
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Requirements for DHHS
Workforce
• DHHS workforce members must
– Apply for NPI by schedule required by
facility/division
– Report NPI data to facility/division NPI
Contact
– Maintain data supplied to obtain NPI
changes
• Updates to be made within 30 days of change
– Report appropriate changes to
facility/division NPI Contact
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How to Obtain an NPI
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Before You Apply
• Collect the following information
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SSN or Individual Taxpayer Identification Number
Date of Birth
Country of Birth
State of Birth (if Country of Birth is U.S.)
Gender
Mailing Address
Practice Location Address and Phone Number
Taxonomy Code(s)
State License or Certification Information (required
for certain Taxonomy Codes)
– Contact Phone Number and Email Address
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Taxonomy Codes Explained
• An additional, unique, 10 position number to be
listed on NPI application
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–
Minimum of one required; up to 14 allowable
Some require license/certification number
• Provides additional information on provider
(replaces missing legacy ID “intelligence”)
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–
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Provider Type
Classification
Area of Specialization
• Situational use on transactions – requirement TBD
by each health plan
–
DHHS assuming all plans will require
• Taxonomy Code list available at
www.wpc-edi.com/taxonomy
–
Use “Individual or Groups (of Individuals)” list
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Taxonomy Codes – cont’d
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How to Apply
• Two options available at
https://nppes.cms.hhs.gov/
– Paper Form
•
•
Make a copy before mailing
Keep notification letter of assigned NPI
– Electronic Form – Recommended
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•
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Self-assigned ID and Password – store in safe place
Print every page before advancing
Keep notification email of assigned NPI
• Helpful HINT: Review CMS NPI Viewlet before
applying!
– http://www.cms.hhs.gov/apps/npi/npiviewlet.asp
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How to Report NPI Data to
Facility/Division
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What to Report
• Provide a copy of the NPI
assignment letter/email
• Include Taxonomy Code(s) listed on
application
• Give to NPI Contact designated by
your Facility or Division
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Your NPI Contacts Are
• Name
– Phone
– Email Address
– MSC Code
• Name
– Phone
– Email Address
– MSC Code
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Reporting Schedule
• Facility/Division Schedule to be
inserted here
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NPI Resources Available
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NPI Resources
• Centers for Medicare and Medicaid
Services (CMS)
– http://www.cms.hhs.gov/apps/npi/01_overvie
w.asp
• DHHS HIPAA Web Site
– http://hipaa.dhhs.state.nc.us/hipaa2002/iden
tifiers/identifiers.html
– Contains Helpful Hints, FAQs, and other
useful information
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NPI Resources – cont’d
• NPI Enumerator
– https://nppes.cms.hhs.gov/
– [email protected]
– 1-800-465-3203 or TTY 1-800-692-2326
– Can provide copies of NPI notification letter
if lost
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