Who must use an NPI and when

What is NPI?

Individuals, groups, or organizations that offer medical or other health services or products are now assigned identity numbers by health plans.

As a result, providers who work with a variety of health plans have various identification numbers. All health plans will use the NPI provider lookup tool, which is a unique identifying number for health care professionals.

The NPIs will be used by health care providers, all health plans, and health care clearinghouses in HIPAA-mandated administrative and financial activities.

The National Provider Identifier (NPI) is a unique 10-digit identification number issued to healthcare providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

Any healthcare practitioner or organization that is a HIPAA-covered entity must receive NPI numbers. The following are examples of HIPAA-covered entities:

  • A healthcare provider who conducts certain transactions in electronic form.
  • A healthcare clearinghouse.
  • A health plan, such as commercial plans, Medicare, and Medicaid.

You are regarded as a HIPAA-covered entity if you electronically transfer personal health information under a HIPAA standard transaction.

If a covered entity engages with a business associate who will have access to personal health information, the business associate must sign a Business Associate Agreement (BAA) that specifies what the business associate performs and that the business associate is HIPAA-compliant.


When will the NPI be used?

The NPI must be used by health plans, health care clearinghouses, and those health care providers who conduct electronic transactions specified by HIPAA two years after the proposed standard is adopted. Small health plans have three years to comply with the law.

What is the purpose of NPI?

The NPI is a unique identifying number that the federal government will assign to healthcare professionals. Its goal is to boost the healthcare system’s efficiency while also reducing fraud and abuse.

Leave a Comment

Your email address will not be published. Required fields are marked *