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National Provider Identifier

Do not let the implementation of the National Provider Identifier (NPI) disrupt your cash flow. The Health Insurance Portability and Accountability Act (HIPPA) requires all covered health care entities (practitioners and facilities) to apply for and obtain an NPI which is to be used in all HIPPA transactions. Your current unique billing (commercial and government payer legacy) numbers cannot be sent in your electronic transitions after May 23, 2007.

The UHIN community of Payers, Providers, Government Agencies and Provider Associations urge you to start the process now. The following steps will help you complete the process:

  • Verify all provider legacy numbers with all payers – this will help you as you build your crosswalk from your NPI number(s) to your existing legacy number(s)
  • Apply electronically for the NPI(s) at https://nppes.cms.hhs.gov
  • Notify Payers of your NPI number(s)
  • Work with your practice management (software) vendor to make sure the NPI number(s) are positioned in the correct field of the electronic transactions
  • Consider validating your transactions with a third party certifier such as Claredi
  • Set up electronic transaction testing with Payers
  • Set up paper form testing with Payers

 

The amount of work required for the NPI conversion is directly related to the number of Payers to whom you submit claims. There is much to be done and some of this may take a considerable amount of time. Please do not wait to begin this process.

We recommend that you use UHIN Standard #51 National Provider Identifier (NPI) to help you understand how to accomplish some of these tasks (this standard can be found on the UHIN website at www.uhin.com)

NPI Check List

Information you will need before you apply for your NPI

Provider Demographics
  • Provider Name (legal name – the name reported to the IRS)
  • Provider Date of Birth
  • State of Birth (if Country is US)
  • Country of Birth
  • Provider Gender
  • Social Security Number
  • Domestic Address
Practice Information
  • Primary Practice Address
  • Primary Practice Location Phone Number
  • Mailing Address
  • Taxonomy (provider type)
  • ALL Provider Legacy Numbers (commercial and government payer assigned billing numbers)
Contact Information
  • Contact Person Name
  • Contact Person Phone Number
  • Contact Person E-mail 
Beginning July 1, 2010

PEHP will no longer be administering any CHIP medical or dental plans.

PEHP will continue to pay CHIP claims with dates of service prior to July 1, 2010.

Start preparing now....

Start preparing now for the electronic healthcare transactions change to Version 5010 and the ICD-10 conversion. Speak with your practice management vendor or clearinghouse about these coming changes.

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