PRACTICE BULLETIN
DEADLINE APPROACHING FOR NATIONAL PROVIDER IDENTIFIER
Mirean Coleman, MSW, LICSW, CT
Senior Policy Associate for Clinical Social Work
October 2006
The compliance date for the National Provider Identifier (NPI) is May 23, 2007. After this date, clinical social workers should use only NPIs to identify themselves in standard transactions such as claims, referrals, remittance, and eligibility and claim status inquiries and responses.
Background
The Federal Register issued on January 23, 2004, released the final rule on the Health Insurance Portability and Accountability Act’s (HIPAA) Standard Unique Health Identifiers for clinical social workers and other health care providers, and announced the adoption of the NPI as the standard to be used in filing and processing health and mental health claims.
A health care provider is defined in the HIPAA regulations 42 United States Code (U.S.C.) 1395x(u) as a provider of medical or health services, and in 42 U.S.C. 1395s(s) as any other person or organization who furnishes bills or is paid for health care in the normal course of business. The 42 U.S.C. 1395s(s) specifically includes clinical social worker services as health care providers.
Clinical social workers who are private practitioners, meet the “health care provider” definition, transmit health information electronically, or use business associations to transmit information electronically on their behalf must comply with HIPAA regulations and obtain an NPI. Clinical social workers who do not use electronic standards and file paper claims should also apply for an NPI since third-party payers have adopted this identifier for paper claims as well. Social workers are urged to apply for the NPI well in advance of the May 2007 deadline so that payers have sufficient time to integrate the new NPIs into their electronic claims and payment systems.
Categories of NPI
The NPI is a 10-digit numeric identifier, which will uniquely identify and numerate clinical social workers on the national level. There are two categories of NPIs:
- Entity Type Code 1 is issued to individuals such as clinical social workers, physicians, psychologists, and nurses.
- Entity Type Code 2 is issued to health care providers that are organizations, including hospitals, home health agencies, and group practices.
Application Process
The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign the NPI. The application process for the NPI is free, simple, and quick. There are five sections to complete, which include:
Section 1: Basic information – Reason for application and entity type
Section 2: Identifying information – Name, credential, date of birth, gender, etc.
Section 3: Mailing address, practice location address, and other provider identification numbers such as Medicare or Medicaid provider numbers. In addition, this area requests your license number and provider taxonomy code, which is 1041C0700X for clinical social workers.
Section 4: Certification statement – Clinical social worker’s signature or authorized official’s information and signature for the organization.
Section 5: Contact person – For entity type 2 applications, the designated person in the organization to receive the NPI notification.
Clinical social workers may apply for the NPI by using the Web-based NPI application process at https://nppes.cms.hhs.gov To obtain a paper application, call 1-800-465-3203 or TTY – 1-800-692-2326.
Benefits
There are many benefits to having an NPI. One significant benefit is that clinical social workers will no longer have to use and keep track of various identifiers with different health plans when conducting standard transactions and filing claims. The clinical social worker will have one permanent identifier that they maintain regardless of job or location changes. Overall, the NPI is expected to:
- Produce faster, more accurate payments;
- Facilitate and simplify coordination of benefits; and
- Simplify health care providers’ billing systems.
Resources
NASW has a NPI hotline to provide information to members and assist with their questions. To access the hotline, call 202-408-8600, ext. 497.
In addition, the following NPI products have been prepared for members:
- National Provider Identifier. Available at http://www.socialworkers.org/practice/clinical/csw052005.asp
- The National Provider Identifier and the Clinical Social Worker. Available at http://www.socialworkers.org/practice/clinical/csw0704.pdf
- HIPAA Highlights for Social Workers: National Provider Identifier. Available at
http://www.socialworkers.org/hipaa/providerInfo.asp?back=yes - CMS also offers information on the NPI to clinical social workers and other health care providers. The resources are available at:
http://www.cms.hhs.gov/NationalProvidentStand/ - http://www.cms.hhs.gov/NationalProvidentStand/07_Questions.asp#TopOfPage