March 27, 2007 Bottom Line

Bottom Line: National Provider Identifiers Coming in May

Effective May 27, many health plans—including Medicare, Medicaid, and private health insurance plans—and all health care clearinghouses will be required to accept and use the National Provider Identifier (NPI). The NPI is the health care provider identification system adopted by the U.S. Department of Health and Human Services as part of the implementation of the Health Insurance Portability and Accountability Act (HIPAA), and will eliminate the need for health care providers to use different identification numbers when conducting business with multiple health plans.

All providers considered covered entities under HIPAA and those who file claims electronically or use a clearinghouse to bill insurance are required to apply for an NPI. All other health care providers are eligible to receive an NPI if they desire.

Q: Who may apply for the NPI?

Speech-language pathologists and audiologists who bill electronically for their services are required to have an NPI by the May deadline. All SLPs and audiologists, regardless of their HIPAA status, are eligible and encouraged to apply for the NPI.

Q: How do I obtain an NPI?

Audiologists and SLPs can apply online for their NPI by visiting the NPPES Web site or by calling 800-465-3203 to request a paper application.

Q: How long does it take to receive my NPI?

The normal processing time is 15 days. However, according to the Centers for Medicare and Medicaid Services (CMS), the amount of time to obtain an NPI may take longer, depending on the quality of the information in the application and the time needed to verify the provider's Social Security number.

Q: Is there a cost associated with getting the NPI?

No. There is no charge to get an NPI.

Q: What is my taxonimy code?

The taxonimy provider type for speech, language, hearing service provider is 23. The taxonimy number for audiologist is 231H00000X. The taxonimy number for SLP is 235Z00000X.

Q: Should I continue to use other legacy identifiers after May 27?

No, if you bill electronically for your services you will use the NPI. It is anticipated that insurance companies will soon require the use of the NPI for all providers, regardless of how they submit claims.

Q: I applied for and received an NPI last year, and now have lost the information. What should I do?

Contact the NPI Enumerator at 800-465-3203.

Q: If I obtain an NPI, am I automatically enrolled in health plans as a provider?

No, the NPI process does not eliminate or replace the enrollment process of health plans. The NPI will not permit SLPs to bill the Medicare program.

Q: What online resources exist?

For further information about obtaining an NPI, visit the CMS Web site or contact ASHA at reimbursement@asha.org. For details about ASHA's efforts on SLP Medicare enrollment, visit ASHA's advocacy Web site.

Ingrida Lusis, is director of health care regulatory advocacy. Contact her at ilusis@asha.org or 800-498-2071, ext. 4482.

cite as: Lusis, I. (2007, March 27). Bottom Line: National Provider Identifiers Coming in May. The ASHA Leader.

  

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