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Everything You Need to Know About National Provider Identifier (NPI) Number

Written by Resurchify | Updated on: November 23, 2022

Everything You Need to Know About National Provider Identifier (NPI) Number

NPI Lookup: The Complete Guide on National Provider Identifier.

In the majority of medical billing situations, you can have to deal with a wrong or missing NPI number, those results in disallowed claims. You may have also noticed that insurance claims to the health plan are not reimbursed without an accurate NPI number.

Every healthcare provider in the United States is given an NPI number. To improve electronic health records, the NPI number was adopted in 1996 as part of HIPPA, the Health Insurance Portability and Accountability Act. Everyone, including the Center for Medicare and Medicaid Services, uses the NPI number to handle payment claims and financial transactions (CMS). 

Table of Content 

  • Introduction
  • What is NPI number?
  • How did NPI come into existence?
  • Why is NPI important?
  • Who needs an NPI number?
  • How is an NPI number used?
  • How do you get an NPI number?
  • How to apply for NPI?
  • Can NPI number be shared with others?
  • What is the taxonomy number?
  • How to look up an NPI
  • Understanding NPI lookup results 
  • Conclusion 
  • FAQs 

What is NPI number?

The NPI number is a ten-digit numerical identification that can be used to identify a healthcare entity at the federal level. With the aid of the NPI registry, you can share your NPI numbers with other physicians, health plans, employers, and payers. The NPI aids in displacing the previously employed healthcare provider identification.

You'll learn that there are two main categories of NPI numbers, namely:

  • Type 1 NPI providers
  • Type 2 NPI providers

People like individual owners, doctors, dentists, surgeons, and others are all part of Type 1 providers. A provider's qualification is taken into account for just one number.

The organizations that fall within the category of Type 2 NPI providers include some intensive care centers, hospitals, physician groups, health systems, health professionals that are organized, and so on.

How to Check NPI Number?

You can check the NPI number of health providers on www.npichecker.com. NPI Checker is a medium dedicated to availing details about medical and healthcare service providers at your fingertips. They provide you the information about millions of physicians, doctors, dentists, and other healthcare providers.

How did NPI come into existence?

As per HIPPA, which stands for the Health Insurance Portability and Accountability Act of 1996, every sort of medical professional needs to have their own unique health identity. With the assistance of the department of health and human services, the final regulation establishing the NPI as the code number is developed. Human Services and the Department of Health assist at the beginning of the NPI's deployment.

Why is NPI important?

Prior to the establishment of NPI numbers, there was a system of identifying numbers provided to healthcare suppliers and providers by health plans and deferral payers. However, the problem was that the identification numbers were not uniform. Through the use of this method, a single provider who had enrolled in numerous health plans will end up with multiple identification numbers. Due to this, submitting the provider's claim was extremely difficult, and it frequently resulted in providing the same identifying number to several healthcare providers through various health coverage.

The NPI established the definitive standard for having a unique health identifier for each and every healthcare provider in response to all of this complexity. The claims procedure can be made simpler with the use of national standards, which also lessens the strain on healthcare providers. Providers are urged to use NPI numbers when sending any health-related information in electronic form transactions. The goal of NPI is to use NPI to enhance the Medicare and Medicaid programs as well as several other federal health programs.

Who needs an NPI number?

To obtain the NPI number, medical documents that often fall within HIPPA rules must be submitted. Any healthcare provider, healthcare clearing house, or organization that handles transactions must also have this NPI number. Many businesses and service providers under this used hospital billing companies to execute their claim submissions.

Patients who have their health information communicated electronically in connection with a transaction are regarded as having an NPI number, and this transmission is carried out with the assistance of a company or healthcare organization. Once a provider receives their NPI number, it can't be altered and will stay with them irrespective of their profession or place of employment.

The companies and suppliers include:

  • Clinics
  • Ambulance services
  • Clinical sports personnel
  • Clinical therapists
  • Group practices
  • Dentists
  • Insurance companies
  • Hospitals 
  • Nurses
  • Opticians 
  • Pharmacies 
  • Nursing homes
  • Physician therapists 
  • Physicians 
  • Medical research facilities 
  • Licensed therapists 

How is an NPI number used?

The NPI number for each provider or company serves as the unique ID for all accounting and financial transactions. Every healthcare plan uses it for every type of transaction mechanism. The health plans give ID numbers to each and every healthcare provider. They must use a separate ID based on the type of health care plan to which they submit their claims.

The use of universal NPI numbers has improved the efficiency of invoicing and tracking in recent years. NPI number is utilized with the aid of electronic transactions in HIPPA. Many healthcare professionals use it as well as in other connected communications and healthcare activities to distinguish themselves. Doctors also utilize them to prescribe medication, by health insurance companies to transact business and communicate with one another, and by patients to locate their health history. Additionally, the Department of Health and Human Services uses it to track fraud and exploitation cases as well as for other purposes.

How do you get an NPI number?

The easiest option for healthcare organizations and providers to obtain an NPI number is to apply through the National Plans and Provider Enumeration System (NPPES). The registration takes about twenty minutes to complete, and you'll get your NPI number after around ten days. Users must first create their username and password in order to enter the management system using an identification (I&A). Afterwards, you can use NPPES to authenticate in using the credentials.

Providers can also register for an NPI number with the assistance of the organizations acting on their behalf. The providers may also use a printed application form to register. The NPI numbers are helpful for the speedy managing the revenue cycle as well as for medical claims. Since the NPI is collected with the aid of HIPPA laws, which is with the help of tracking healthcare services and reimbursement, the health plan will reject claims that are presented without a valid registered NPI number.

How to apply for NPI?

The three methods for requesting an NPI number are as follows and are listed below:

  • Applying online (nppes.cms.hhs.gov)
  • Create the application in writing and mail it.
  • Using the huge organization's readily available electronic file exchange (EFI)

Online and paper application 

The doctor and other applicants can apply online, which is the simplest and quickest method. The following criteria must be met in order to complete your application form:

  • The NPI you currently have
  • The UPI number
  • Your identification number
  • The taxonomies you use
  • Mailing address and business address.
  • A contact number
  • Information about the enumerator, including their name

Suppose you are filling out the application on behalf of another individual. In that case, they will also need to provide information such as their country of origin, place of birth, date of birth, and a taxpayer security number. All of this data is necessary. NPI Enumerator can be used to finish applications or update forms. Only on the NPI Enumerator's request will you be able to obtain the form.

If you would like to make a copy of this form, the NPI Enumerator can be reached through the methods listed below:

  • Contact no: (800) 465-3203 or TTY (800)692-2326
  • Email: [email protected]
  • Mail: NPI Enumerator, P.O. Box 6059, Fargo, ND 58108-6059 

EFI offering bulk Enumerator for large organizations 

Another name for EFI is bulk enumerator. The physicians, other healthcare professionals, groups of healthcare professionals, and others who use this approach receive the organization (EFIO) when filing for NPI on their behalf. Rather than a group of providers or individual providers, the EFIO in this case is in charge of obtaining the NPI for them. It is the distinctive feature of EFIO that it can store hundreds or thousands of files.

EFI can also be used to modify and update the provider's current NPI information.

Can the NPI number be shared with others?

Yes, you can give orders your NPI number as well. You can communicate the requirement for an NPI number with other doctors and providers when submitting claims for the patient's treatment. This number is comparable to the UPIN number employed in the NPI's initial setup. The other person will require your NPI in order to bill on your behalf.

You will also need your NPI number from hospice and home health organizations, in addition to the other doctors, in order to bill for your services.

What is the Taxonomy Number?

Physicians and others who use the NPI application can register their primary and secondary taxonomy codes. The taxonomy codes listed below are those that are mentioned below:  

Taxonomy
Codes
Family practices
207Q00000X
General practices
208D0000X
Hospitalist
208M0000X
Emergency medicine
207P0000X
Internal medicine
207R00000X
Sport medicine
207PS0010X
Sports medicine
207RS0010X
Nephrology
207RN0300X
Critical care medicine
207RC0200X

How to look up an NPI?

There really are numerous ways to check up on a provider organization. You can go to the authorized NPPES NPI Registration website, which provides a free facility to all. The process starts when the NPI number or identity is entered at the beginning. As a result, the data needed for this include the provider's initial and last name, NPI number, kind of NPI icon specified, location, mobile number, etc.

With the aid of the search result windows, which you can download, you can view the outcome. It is also accessible through interfaces for application programming.

Understanding NPI Lookup Results 

  1. NPI: As previously indicated, the national provider identification (NPI), which is given to a provider or group of providers, is regarded as a special 10-digit number.
  2. Enumeration date: Enumeration dates are determined by the day the NPI was issued.
  3. NPI type: The two types of NPI are as stated above. Individual providers are given Type 1 assignments, whereas groups or other organizational providers are given Type 2 assignments.
  4. Status: You can determine whether an NPI number is active or inactive by looking at its status level.
  5. Address: Here, the address linked to the NPI, which may be either the mailing address or any other form of secondary address, was taken into account.
  6. Taxonomy: This is regarded as the categorization type of healthcare practitioner or any other form of expertise. You are allowed to choose more than one taxonomy code, but only one of them may be used as the principal category.
  7. Endpoint information: Where the customer or service provider may access the service is what is taken into account in this field, and it can be done either directly or with the aid of a website.

There are other additional aspects to take into account, including the endpoint description, content kind, use, affiliation, and more.

Conclusion 

All pertinent information on the National Provider Identifier (NPI) number is provided above. You may clearly understand what NPI is and the information you need to be aware of. Maintaining the NPI number is simple and streamlines the organization's and the doctors' workloads. Here, the problem-causing misperception of giving the identical identifying number to another person has been resolved with the aid of the NPI number. As a result, NPI has now made tasks and labor for all people, including the group of organizations and providers, dentists, nurses, and so forth, simple.

Frequently Asked Questions

Are several NPI sites possible?

Yes, NPI can manage several locations.

Why is NPI necessary?

NPI is necessary for the quicker transmission of patient data electronically.

Can a single person have two NPIs?

A person is only permitted to have one NPI number; however, service providers are permitted to have several NPIs.

How are NPI numbers assigned?

The National Plan and Provider Enumeration system assigns NPI numbers (NPPES).

Does NPI have an expiration date?

No, it won't run out.

Does NPI alter the following residency?

It remains unchanged even if you alter your procedures or your working environment.

References


         

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