All the healthcare systems and services run organically in countries like US and UK. Every organization and healthcare provider receives a unique identification number to remain in the government's records. That is why in 1996, NPI got introduced as part of the Health Insurance Portability and Accountability Act (HIPPA). This article will give you a clear idea of what NPI is and its usage.
What is National Provider Identifier (NPI)?
National Provider Identifier (NPI) is a ten-digit numerical identification number that allows others to recognize an organization, individual provider, or healthcare service provider. An organization can share this NPI number with other employers, providers, health planners, and firms for billing purposes. CMS.gov's Administrative Simplification mandates the Health Insurance Portability and Accountability Act (HIPAA) of 1996 to adopt this unique & standard health identification number for each healthcare provider.
The NPI satisfies the need to represent an organization uniquely. According to the modern norms, all healthcare service providers, health planners, and other health-related services must employ NPI numbers for their managerial dealings and financial transactions under HIPAA. The NPI number replaced the age-old Unique Physician Identification Number (UPIN), which is essential for identifying Medicare services that early payers, including commercial healthcare insurers, used.
Types of National Provider Identifier (NPI)
NPI number assignment is of two types:
- Type-1 NPI providers: This type of NPI gets assigned to individuals such as sole proprietor businesses, physicians, dentists, and surgeons.
- Type-2 NPI providers: This type of NPI gets assigned to organizations and service providers like health systems, care facilities, physician groups, hospitals, medical research facilities, etc.
Who Needs NPI Identification Number?
The healthcare providers, medical organizations, nursing service providers, healthcare clearinghouses, etc., executing financial transactions or conducting management of health records under HIPPA regulations require receiving the NPI. It also comprises organizations and providers with a medical billing company to process their medical claims. HIPAA mandates that every business, individual, medical organization, or health agency that transmits a patient's health details in digital form in connection with a transaction must have an NPI number. Also, note that once a service provider or an organization receives their NPI, no one can alter it and remain with them regardless of their circumstances or where they live or operate.
HIPPA-covered service providers and healthcare firms include:
- Ambulance Companies
- Clinical Social Workers
- Clinical Therapists
- Group Practices
- Health Care Clearinghouses
- Health Care Plans
- Home Health Agency (HHA)
- Licensed Therapists
- Medical Equipment Suppliers
- Medical Laboratories
- Nursing Homes
- Nursing Homes
- Physical Therapists
- Physician Assistants
- Residential Treatment Centers
Use of National Provider Identifier (NPI)
NPI's first and foremost purpose is to enable organizations and develop a national standard for transactions under the HIPAA. Apart from regular transactions, it also allows various providers to search for National Plan and Provider Enumeration System (NPPES) information. Since NPI is an intelligence-free number, it does not hold personal details or information other than the owner's name and a business address.