ANSI - American National Standards Institute
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CMS Announces Standard Unique Health Identifier for Health Care Providers


New York, Jan 26, 2004

The Centers for Medicare & Medicaid Services (CMS) have announced the adoption of the National Provider Identifier (NPI) as the standard unique health identifier for health care providers to use in filing and processing health care claims and other transactions. A Federal Register notice on January 23, 2004, announced the final rule establishing the NPI as the standard unique health identifier, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).The final rule is effective May 23, 2005.

As part of its administrative functions, a health plan (which may be a federal program, such as Medicare, or a private health plan) assigns identification numbers to its providers of health care services and its suppliers. The identifiers it assigns are frequently not standardized within a single health plan or across health plans, which results in the single health care provider having different identification numbers for each health plan, and often having multiple billing numbers issued within the same health plan. This complicates the health care provider's claims submission processes and may result in the assignment of the same identification number to different health care providers by different health plans.

The NPI is a new number that will be issued through the National Provider System, which is being developed by CMS. Use of the NPI will reduce costs and improve efficiency in the nation's health care system by eliminating the need for health care providers to maintain, keep track of, and use multiple identification numbers assigned by the various health plans they bill.

Adoption of NPI is the latest step in implementing the administrative simplification provisions of HIPAA. All health care providers, whether or not they are covered entities under HIPAA, are eligible to be assigned NPIs. Health care providers are covered entities if they transmit any data in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard. Covered entities must use NPIs in standard transactions no later than the compliance dates.

CMS will provide the health care industry with information relating to the NPI, including the application process and the availability of the NPI application forms, closer to the effective date. The compliance dates for all but small health plans is May 23, 2007. The compliance date for small health plans is May 23, 2008.

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