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  National Provider Identifier (NPI) and the application process.


National Provider Identifier Standard (CMS Overview)

NPI Taxonomy

Information about the The NPI is mandated as part of the Health Insurance Portability and Accountability Act (HIPAA) uniform health care identifier provisions. The NPI is a unique, all numeric, ten digit number that will be used by covered health care providers in filing and processing electronic health care claims and other transactions such as eligibility inquiries and responses, claims status inquiries and responses, and remittance advices.

Many health plans, including Medicare, Medicaid, and private health insurers, and all health care clearinghouses, must accept and use NPIs in standard transactions by May 23, 2007. Small health plans have until May 23, 2008. After those compliance dates, health care providers may use only their NPIs to identify themselves in standard transactions where the NPI is required.

This number is issued through the National Plan and Provider Enumeration System (NPPES) developed by the Centers for Medicare & Medicaid Services (CMS). The NPI will replace all "legacy" identifiers (including your South Carolina Medicaid Provider number) that are currently being used. The transition from existing Medicaid provider identifiers to NPIs will occur as follows:

  • Beginning January 3, 2006, the South Carolina Department of Health and Human Services (SCDHHS) systems will accept electronic claims with an NPI, but an existing legacy Medicaid number must also be on the claim. (Refer to the S.C. Medicaid Companion Guides for information regarding placement of the NPI. The guides are located at (Companion Guides.) SCDHHS will reject any claim that includes only an NPI.

  • Pharmacists should refer to the Pharmacy Services NPI Medicaid bulletin for information on the NPI.
    NPI training information
    is also available for pharmacists.

  • Effective May 23, 2007, SCDHHS systems will only accept NPI numbers for providers. The NPI must be used on both electronic and paper claims.

Providers are encouraged to learn about the NPI and the impact it will have on their processes and systems. Covered providers are also encouraged to utilize one of the following avenues to apply for an NPI. To clarify whether you are a covered provider you can contact the enumerator at the number listed below or refer to the web sites listed below.

  1. Web-based application at https://nppes.cms.hhs.gov
  2. Paper applications -Call the enumerator at 1-800-465-3203 or TTY 1-800-692-2326

With your permission, an organization may submit your application in an electronic file. This could mean that a professional association or perhaps a health care provider who is your employer could submit an electronic file containing your information and the information of other health care providers. This process will not be available until the fall of 2005. For example, the National Council for Prescription Drug Programs (NCPDP) has announced plans to become a CMS certified Electronic File Interchange (EFI) Submitter for obtaining and maintaining NPIs on behalf of pharmacies. For more information refer to http://www.ncpdp.org.