AAP News Vol. 28 No. 6 June 2007, p. 2007266
© 2007 American Academy of Pediatrics
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NEWS AND FEATURES

Don't have an NPI? Implement a contingency plan

from the AAP Department of Practice

The deadline to obtain and begin using a National Provider Identifier (NPI) was May 23. If you submit claims electronically (or send paper claims to a clearinghouse that submits them electronically on your behalf), you are required to use the NPI in place of other provider identifiers (such as the Uniform Provider Identification Number or UPIN).

The NPI was established as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NPI Rule was published on Jan. 23, 2004, and affects all HIPAA covered entities.

If you haven't yet obtained your NPI, it's easy to get one. You can apply for an NPI online through the National Plan & Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/NPPES/Welcome.do.

If you have an NPI but haven't yet tested its use with your payers, you should implement a contingency plan to document how your practice plans to work toward compliance. You can find more information on contingency planning at www.cms.hhs.gov/National ProvIdentStand/Downloads/NPI_Contingency.pdf.

As part of the NPI rule, the Centers for Medicare & Medicaid Services (CMS) planned to allow HIPAA-covered entities to obtain bulk lists of provider identifiers. The original intent was to allow payers to obtain NPIs for their contracted providers all at once, rather than collecting them individually from the providers. CMS now has determined that information supplied to apply for the NPI falls under the Freedom of Information Act and, therefore, must be made publicly available.

On June 28, 2007, CMS made this information available on the Web as a downloadable file and/or a query-only database. It should be noted that provider Social Security numbers, IRS Individual Taxpayer Identification Numbers and dates of birth will not be disclosed. See the table for a list of information that will be made publicly available on the Web.

CMS is encouraging providers who have received NPIs to check the information in their NPPES records to ensure it is current. CMS also has noted that providers who submitted optional information (e.g., "other name," "other provider identifiers") on their NPI applications may wish to delete that information. Providers may check their NPPES listing online at https://nppes.cms.hhs.gov/NPPES/Welcome.do (case-sensitive).

For additional resources on the NPI and HIPAA, visit the AAP Member Center.





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