Medicare’s National Provider Identifier Information (NPI)

The NPI will replace the provider identification numbers that providers use today in the HIPAA standard transactions that they conduct with health plans. Those transactions include the electronic claim, eligibility inquiry and response, claim status inquiry and response, payment and RA, prior authorization/referral, and COB transactions. Providers who conduct any of those electronic transactions must obtain their NPIs and be ready to use them to identify themselves, and possibly other providers, in those transactions before May 23, 2007. Providers and suppliers are required to include their NPI on the 04/2006 version of the CMS-855 Medicare enrollment application when they apply to enroll in Medicare. CMS urges all providers to visit their Web site and become familiar with the NPI and how it will be used. CMS also encourages all organizations and associations to inform their members about the need to obtain, test, and use the NPI.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.