For a number
of years third party payer claim forms have required an NPI number (National
Provider Identifier number) on all paper insurance claims. Now all electronic transactions including
claims and eligibility verifications must also have an NPI number on the
claim. The latest changes concern how
health care providers use NPIs.
The NPI is a
government-issued identification number for a variety of health care providers:
Entity Type 1 (Individual NPIs) and Entity Type 2 (Organizational NPIs). Type 1
indicates solo practitioners; Type 2
is used for “Organizational” providers including clinics, hospitals, dental
schools, and group practices.
Under new
regulations both Entity Type 1 and Entity Type 2 claims must include an NPI on
any claim for prescription drugs for patients who have Medicare Part D
prescription drug benefits. Also a
specialist may now request the Type 1 NPI from a referring dentist in order to
complete the claim form.
There are
other requirements too involved to discuss thoroughly in a brief blog. For more information, go to www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplifcation/NationalProviderStand/education.html. Scroll to the “Downloads” heading and click
on “NPI Requirement for Prescribers”.
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