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N ational P rovider I dentifier Type 1 Workforce Training

N ational P rovider I dentifier 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

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N ational P rovider I dentifier Type 1 Workforce Training

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  1. National Provider Identifier Type 1Workforce Training Month Day, Year The NPI will become the standard, unique identifier for health care providers in HIPAA Transactions

  2. 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 DHHS/DIRM Projects Office - NPI Initiative

  3. National Provider Identifier Requirement DHHS/DIRM Projects Office - NPI Initiative

  4. 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 DHHS/DIRM Projects Office - NPI Initiative

  5. 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 DHHS/DIRM Projects Office - NPI Initiative

  6. 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 • DMH/DD/SAS facilities • DPH State Lab and CDSAs • OES Schools DHHS/DIRM Projects Office - NPI Initiative

  7. 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 DHHS/DIRM Projects Office - NPI Initiative

  8. Who Must Get an NPI in This Facility? • List Provider Types Here DHHS/DIRM Projects Office - NPI Initiative

  9. 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 DHHS/DIRM Projects Office - NPI Initiative

  10. 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/ DHHS/DIRM Projects Office - NPI Initiative

  11. 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/identifiers/identifiers.html) • DHHS Policy under development to support decision DHHS/DIRM Projects Office - NPI Initiative

  12. 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 DHHS/DIRM Projects Office - NPI Initiative

  13. How to Obtain an NPI DHHS/DIRM Projects Office - NPI Initiative

  14. Before You Apply • Collect the following information • 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 DHHS/DIRM Projects Office - NPI Initiative

  15. Taxonomy Codes Explained • An additional, unique, 10 position number to be listed on NPI application • Minimum of one required; up to 14 allowable • Some require license/certification number • Provides additional information on provider (replaces missing legacy ID “intelligence”) • 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 atwww.wpc-edi.com/taxonomy • Use “Individual or Groups (of Individuals)” list DHHS/DIRM Projects Office - NPI Initiative

  16. Taxonomy Codes – cont’d DHHS/DIRM Projects Office - NPI Initiative

  17. 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 • 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 DHHS/DIRM Projects Office - NPI Initiative

  18. How to Report NPI Data to Facility/Division DHHS/DIRM Projects Office - NPI Initiative

  19. 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 DHHS/DIRM Projects Office - NPI Initiative

  20. Your NPI Contacts Are • Name • Phone • Email Address • MSC Code • Name • Phone • Email Address • MSC Code DHHS/DIRM Projects Office - NPI Initiative

  21. Reporting Schedule • Facility/Division Schedule to be inserted here DHHS/DIRM Projects Office - NPI Initiative

  22. NPI Resources Available DHHS/DIRM Projects Office - NPI Initiative

  23. NPI Resources • Centers for Medicare and Medicaid Services (CMS) • http://www.cms.hhs.gov/apps/npi/01_overview.asp • DHHS HIPAA Web Site • http://hipaa.dhhs.state.nc.us/hipaa2002/identifiers/identifiers.html • Contains Helpful Hints, FAQs, and other useful information DHHS/DIRM Projects Office - NPI Initiative

  24. NPI Resources – cont’d • NPI Enumerator • https://nppes.cms.hhs.gov/ • customerservice@npienumerator.com • 1-800-465-3203 or TTY 1-800-692-2326 • Can provide copies of NPI notification letter if lost DHHS/DIRM Projects Office - NPI Initiative

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