On January 23, 2004, the U.S. Department of Health and Human Services issued a Final Rule on the National Provider Identifier (NPI) system.
To read the entire rule, click here.
This regulation requires that all health care providers that are “covered entities” under HIPAA (which includes all ambulance services that bill electronically for their services, or use a billing company which bills electronically on their behalf) to apply for and use a new “provider number.” This provider number will be the same number that the ambulance service will use when submitting all claims, whether to Medicare, Medicaid, or commercial insurance companies or HMOs. Currently, many payors utilize their own provider numbering system, which can create confusion and inconsistency in electronic claims processing. The new regulations will move all covered entities to a standard provider number.
HHS has adopted a “National Provider Identifier” (NPI) system as the standard provider number. This will be a 10-character identifier that will be issued by the National Provider System (NPS), which will be implemented and overseen by the U.S. Department of Health and Human Services. The NPS will collect and maintain information about each health care provider, and will be responsible for activating and de-activating provider numbers as appropriate.
This new regulation goes into effect on May 23, 2005 and the compliance deadline is May 23, 2007. This means that HHS anticipates making National Provider Identifier numbers available beginning on May 23, 2005, at which time providers will be permitted to apply for them. However, all covered entities must obtain their NPI number and use it on all standard HIPAA transactions (such as electronic claim filing) no later than the May 23, 2007 compliance deadline.
(c) Copyright, 2004, Page, Wolfberg & Wirth, LLC.