PRACTICE NEWS ALERT

National Provider Identifier

Mirean Coleman, MSW, LICSW, CT
Senior Policy Associate  

Implementation for the National Provider Identifier (NPI) begins May 23, 2005. This identifier is a requirement of the Health Insurance Portability and Accountability Act (HIPAA) and must be used by health care providers including clinical social workers, health plans, health care clearinghouses, and other covered entities that conduct electronic transactions. The compliance date is May 23, 2007. Small health plans have until May 23, 2008 to comply. After these dates, clinical social workers must use only their NPIs to identify themselves in standard transactions such as claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance advices.

The NPI will replace current provider identifiers used by clinical social workers and eliminate the need for them to use different identification numbers to identify themselves when conducting standard transactions with multiple health plans. More information about the NPI can be found in the NASW’s Practice Update, “The National Provider Identifier and the Clinical Social Worker” at http://www.socialworkers.org/practice/clinical/default.asp

Clinical social workers should be aware of the following:

• Although you may receive notices about the NPI from third-party payers that you conduct business with, you only need to apply for an NPI once.
• Applying for an NPI does not replace enrollment or credentialing processes with any third-party payer.
• Health plans might request that you begin using your NPI prior to the compliance date.

Application

Clinical social workers may apply for the NPI in the following ways:

• Beginning May 23, 2005 , electronic applications are available at https://nppes.cms.hhs.gov
• Beginning July 1, 2005 you may prepare a paper application and submit it to the NPI Enumerator. The application will be available at https://nppes.cms.hhs.gov. You may also call the Enumerator for an application at 1-800-465-3203 or TTY 1-800-692-2326.
• In the fall of 2005, an employer, with your permission, may submit your application in an electronic file containing your information and the information of other health care providers.

Additional Links and Resources

 

http://www.cms.hhs.gov/hipaa/hipaa2

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SF0527,odf

 

http://www.socialworkers.org/hipaa/providerInfo.asp

 

 

Department of Health and Human Services. (2004, January 23). Federal Register (Vol. 69, No. 15). Washington , DC : Government Printing Office.