Health & Fitness

Why Is It Important to Understand How NPI Works?a

An NPI is a numeric identifier consisting of 10 digits. It does not contain information about you, such as where you practice, your type of provider, or your specialty. Regardless of your changes to your name, address, taxonomy, or anything else, your NPI won’t be changed.

Understand How NPI Works

Providers must use the NPI Registry as a substitute for other provider identifiers, such as.

  • PTAN(Provider Transaction Access Number).
  • QIES(Quality Improvement Evaluation System).
  • CASPER(Certificationand Survey Provider Enhanced Reporting).
  • NSC(National Supplier Clearinghouse).

What Are NPI Numbers for?

To legally conduct transactions or use health records under HIPPA, healthcare providers, healthcare clearinghouses, and healthcare organizations must obtain an NPI. Medical billing companies process the claims of organizations and providers that use them.

A national patient identifier number is required for anyone who electronically transmits patient health information, whether for a business or healthcare institution. NPIs are issued to providers once, and they cannot change it once they receive it regardless of their position or location.

Among the covered entities and providers under HIPAA are.

  • Ambulance companies
  • Clinical Social Workers
  • Chiropractors
  • Clinical Therapists
  • Dentists
  • Clinics
  • Group Practices
  • Health care plans
  • Health care clearinghouses
  • Home health care agencies (HHA’s)
  • Licensed Therapists
  • Hospitals
  • Nurses
  • Medical Equipment suppliers
  • Nursing homes
  • Opticians
  • Medical Laboratories
  • Optometrists
  • Pharmacies
  • Physical therapists
  • Residential Treatment Centers
  • Pharmacists
  • Physicians
  • Psychologists
  • Physician Assistants

How do NPI numbers work?

Each healthcare plan must use an NPI number for every administrative and financial transaction, as it is a unique identification number for each provider or entity. Health plans gave each health care provider a unique ID number.

Each health plan had its ID, so providers could use a different ID when submitting a claim. Billing and tracking have become more efficient with the universal NPI number.

Identified electronic transactions in HIPPA use the NPI number. Similarly, healthcare providers may use them as identifiers in healthcare transactions and correspondence.

  • On prescriptions from physicians.
  • Communication and transactions by health plans.
  • The coordination of health plan benefits.
  • Provider identification in electronic medical records.
  • Tracking providers in fraud and abuse cases and other functions by the Health and Human Services Department.

Where can you get an NPI number?

Applicants for National Plan and Provider Enumeration System (NPPES) numbers are most likely to receive them promptly. It will take around 20 minutes to complete the application, and you may receive an NPI number within a week. Individual providers must sign up an account with password through NPPES’ I&A (Identity & Access Management System).

An NPI number can also be obtained by paper form or through an organization on behalf of the provider. The CMS website contains complete instructions.

Revenue cycle management and accurate billing are made possible by NPI numbers.  The HIPAA regulations require that a valid NPI be provided to track healthcare services and reimbursement, so any claim submitted without a valid NPI will be rejected.

About the author

Ashish Arora

Ashish Arora is a digital marketer and blockchain enthusiast. He is running his many blogs and sharing his 3.5+ years of experience with the online community.