Are you a HIPAA-covered healthcare provider? If yes then NPI is mandatory for you. As of May 23, 2007, NPI numbers replaced all legacy identifiers as the go-to provider identification tool in the US healthcare system, including Unique Physician Identification Numbers (UPIN), Medicaid Provider Numbers, and Medicare Provider Numbers. There are two types of health care providers in terms of NPIs:
Type 1:- Health care providers who are individuals, including physicians, dentists, and all sole proprietors. An individual is eligible for only one NPI.
Type 2:- Organizations that are health care providers, including medical associations, hospitals, nursing homes, and the organization created when an individual incorporates him/herself/.
Why do I need an NPI number?
Well, if you attempt to file a claim without an NPI number, it will almost inevitably be refused. And it doesn’t only apply to Medicare claims; for private payers, it’s also the law. So, you better get one of these 10-digit identifiers if you want to get paid for your services.
Do I still need an individual NPI if I’m part of a group or facility that has a group NPI?
“Technically, no, but it is strongly suggested that individual practitioners obtain their own NPIs, because, as CMS states, “… there are circumstances in which certain health plans explicitly require an individual NPI to process claims.
Can I change the information associated with my NPI?
Yes, you can change the information associated with your NPI. In fact, if any information about the provider change, you must notify NPPES within 30 days. In one of three ways, you can do this:
Access the online portal;
Print, complete, and mail this form; or
Call the NPI Enumerator at 1-800-465-3203 to request a form.
Do NPI numbers expire?
Like a diamond, an NPI is forever. “As CMS explains, the NPI of a provider is “intended to be a permanent identifier, and is supposed to remain unchanged even if a health care provider changes its name, address, the taxonomy of the provider, or other information given as part of the original application process for the NPI.