* Most health plans must use National Provider Identifiers
in standard transactions by May 23.
* National Provider Identifier
Overview and Educational Reference Guide, Final Version
The national provider identifier
offers an opportunity to identify the same provider in multiple health programs.
After spirited backlash from the lab community and congressional leaders, CMS expanded the definition so that a lab would be identified by a National Provider Identifier
(NPI) rather than a TIN.
The Centers for Medicare and Medicaid Services (CMS) extended its original May 2007 deadline for the transition from legacy, proprietary physician identifier numbers to the new, national provider identifier
Unfortunately, the article on the National Provider Identifier
sounds more like a sales pitch for the Centers for Medicare and Medicaid Services than a balanced report ("National Provider Identifier
Deadline Is Nearing," March 2007, p.
The deadline for obtaining a National Provider Identifier
(NPI) is fast approaching.
As May 2007 approaches, all provider claims and eligibility systems must be upgraded to use the Health Insurance Portability and Accountability Act of 1996 (HIPAA)-required National Provider Identifier
(NPI) as their sole and unique identification method for all HIPAA standard electronic transactions.
CMS proposed to apply the 50% test to an entity as defined by its Taxpayer Identification Number, rather than a CLIA certificate number or a National Provider Identifier
"To avert one of the problems that came to light as a result of the Medicare claims data release earlier this year, we strongly urge physicians to make sure their information in the national provider identifier
(NPI) database is current."
Examples of the victories included in the model are prevention of federal track-and-trace requirements for prescription drugs; the change in the approach to National Provider Identifier
(NPI) requirements for Medicaid that prevented the rejection of some pharmacy claims; the delay in the implementation of the Medicaid tamper-resistant paper requirement, which allowed time for smoother implementation, preventing the rejection of pharmacy claims; maintenance of Tricare prescriptions by preventing a transition to mail order for this program; and blocking the implementation of Medicaid pharmacy reimbursement cuts.