Feds Explain Provider ID Plans
Health Data Management (September 28, 2005)

The Centers for Medicare and Medicaid Services has published a six-page tutorial on the national provider identifier.

Covered entities under HIPAA must use only the national identifier in HIPAA standard transactions by May 23, 2007. Small health plans as defined in HIPAA have an additional year to comply. Providers can apply for their identifier at https://nppes.cms.hhs.gov.

The tutorial includes a previously announced transition plan for migrating to the identifier. Beginning Jan. 3, 2006, and for the next nine months, Medicare will accept claims with a national provider identifier, but a legacy Medicare identifier also must be on the claim.

Once assigned, a provider’s national identifier will not change regardless of job or location changes. Other tips in the tutorial include:

  • Know the schedule of software vendors and insurance companies to be ready to accept the national identifier. Providers should submit transactions with the national identifier only when an insurer has indicated it is ready.
    Providers must share their national identifier with any entity that needs it to identify the provider in a standard transaction.
  • Review state laws to determine if there are conflicts or supplements to the national provider identifier. Some states may require the identifier to be used on paper claims.

The Centers for Medicare and Medicaid Services is developing a mechanism to permit the bulk processing of national provider applications. This will enable an organization--with provider approval--to send multiple applications within a single electronic file.

Further, the centers expects to publish a notice in coming months to explain its policy for disseminating data from the National Plan and Provider Enumeration System, which will manage the assignment of national provider and health plan identifiers.

Text of the tutorial is available at cms.hhs.gov/medlearn.

Posted to HIPAAcomply 9/28/05