Who must use the NPI and when

Who must use NPI and when

The National Provider Identifier (NPI) is an Administrative Standard under the Health Insurance Portability and Accountability Act (HIPAA).

An NPI is a unique identifier for covered health care providers that was established to improve the efficiency and efficacy of electronic health information transfer.

In their administrative and financial transactions, covered health care providers, all health plans, and health care clearinghouses must use NPIs.

A 10-digit numeric identifier is known as an NPI. It does not contain information about you, such as the state in which you practice, the sort of provider you are, or your area of specialty.

Even if your name, address, taxonomy, or other information changes, your NPI will remain the same.

The NPI must be used in place of other provider IDs in HIPAA standard transactions, such as the Provider Transaction Access Number (PTAN), Online Survey Certification & Reporting (OSCAR), and National Supplier Clearinghouse (NSC).

Who May Obtain an NPI?

An NPI can be obtained by any health care provider (including physicians, suppliers, hospitals, and others).

Individuals or organizations that offer health care are defined as health care providers in 45 Code of Federal Regulations (CFR) 160.103. For further information, go to the Government Printing Office (GPO) website and look up 45 CFR 160.103.

Who Must Obtain an NPI

All HIPAA-covered health care professionals, whether individuals or organizations, must obtain an NPI registry tool.

A HIPAA-covered entity is a:

  • Health care provider that conducts certain transactions in electronic form
  •  A Health care clearinghouse.
  • A Health plan (including commercial plans, Medicare, and Medicaid).

Even if you use a business associate to do so, you are a covered health care provider under HIPAA if you electronically communicate health information in connection with a HIPAA standard transaction.

Who must use the NPI and when

Health care providers as defined in CFR 160.103 are classified as below:-

  1. Ambulance companies
  2. Chiropractors
  3. Clinical Social Workers
  4. Clinical Therapists
  5. Clinics
  6. Dentists
  7. Group Practices
  8. Health care clearinghouses
  9. Health care plans
  10. Home health care agencies
  11. Hospitals
  12. Licensed Therapists
  13. Medical Equipment suppliers
  14. Medical Laboratories
  15. Nurses
  16. Nursing homes
  17. Opticians
  18. Optometrists
  19. Pharmacies
  20. Pharmacists
  21. Physical therapists
  22. Physicians
  23. Physician Assistants
  24. Psychologists
  25. Residential Treatment Centers

When to use NPI?

Having an NPI simplifies the exchange of healthcare information. NPI is used in all HIPAA standard transactions.

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