The 1996 Health Insurance Portability and Accountability Act (HIPAA) established national privacy and security standards for electronic health care transactions, including a national identifier for providers, health plans and employers. Accordingly, by May 23, 2007, healthcare providers and all health plans and clearinghouses must change both their processes and information systems to implement HIPAA’s National Provider Identifier (NPI) regulations.Background on the NPI regulation
- HIPAA mandated regulation
- Effective nationwide on May 23, 2007
- The compliance date for health care payers with less than $5 million in annual revenue is May 23, 2008
What is the NPI?
- A unique 10-digit identification number
- Assigned for life to a provider and de-activated only upon death, retirement, or identity theft
- Replaces multiple legacy provider identification numbers, including Medicare UPINs, commercial payer IDs and state Medicaid IDs
- Contains no identifying information related to the provider – randomly generated
- Independent of key provider information changes, such as practice location or specialty
- Providers have 30 days to update their NPI record
Who is affected by the NPI mandate?
- Health plans
- Organizational providers
- Individual providers
Why is the NPI necessary?
- NPI delivers two-fold benefits for payers and providers:
- Simplifies communication and administration
- Facilitates efficient electronic transmission of certain health information
- Streamlines detection of billing fraud and abuse
- Improves debt collection efforts
What are the challenges of NPI implementation for payers and providers?
- Providers and payers must exchange information
- Technological implementation cost within organizations
What should payers and providers do now to prepare for the NPI?
- Organize project teams to ensure a smooth transition
- Identify and address processes and information system changes
- Evaluate outsourcing solutions offered by technology vendors