The Centers for Medicare and Medicaid Services (CMS) requires that all health care providers, including audiologists and speech-language pathologists, obtain a National Provider Identifier (NPI). All health care providers and organizations are eligible to receive NPIs.
Getting an NPI is free — not having one can be costly.
For more news and updates, go to the NPI page on the CMS website.
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). All health care providers that are 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.
The NPI will eliminate the need for health care providers to use different identification numbers when conducting business with multiple health plans. Many health plans, including Medicare, Medicaid, and private health insurance plans, and all health care clearinghouses are now required to accept and use NPIs.
Even if you do not bill for services, you may need to disclose your NPI to those providers who do (e.g., providers who order lab tests or send patients for diagnostic testing must be identified on the lab's or testing facility's claims). Without the NPI, claims may be adversely affected, with payment delayed or possibly denied.
In other words, getting an NPI is free - not having one could be costly.
There is no charge to get an NPI. Audiologists and speech-language pathologists can apply online for their NPI, free of charge, by applying online or by contacting the NPI Enumerator to request a paper application. It takes less than 5 minutes to apply online and the number is issued within a few minutes.
Note: The provider type is 23 (speech, language, hearing service provider). The taxonomy number for audiologist is 231H00000X. The taxonomy number for SLP is 235Z00000X.
Clinical Fellows without a state license are to apply for an NPI as a student. Under the NPI system, a student is defined as "An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration and/or licensure to provide health care." When the state license is conferred, the applicant will need to update their taxonomy code. The student taxonomy code (needed to complete the application) is 390200000X.
For further information about obtaining an NPI, please visit the NPI page on the CMS website.
Medicare Provider Enrollment and NPIs
CMS requires that new providers and suppliers obtain their NPI prior to enrolling in Medicare. Already enrolled Medicare providers must obtain their NPI before updating any Medicare enrollment information. Providers and suppliers must enter their NPIs on the CMS-855 Medicare provider enrollment applications and submit a copy of their NPI notifications with each CMS-855 application they submit.