HIPAA requires all healthcare providers to use the National Provider Identifier (NPI) for electronic transactions as of May 23, 2007. Providers can obtain and use NPI now according to the following timetable:
NPI TRANSITION TIMETABLE
Date — Highmark — Medicare
1/1/06 — n/a — Accept NPI
2/1/06 — Accept NPI — n/a
10/2/06 — Accept Legacy and NPI — Accept Legacy and expect NPI
5/23/07 — NPI only — NPI only
NPIs are intelligence free (i.e., no numerical identifiers such as state or specialty information) 10-digit self-validating numbers. The digit validation is based upon the Luhn Formula for Modulus 10 digits in which the 10th digit is the product of a formula utilizing the first nine (9) digits.
NPIs can be obtained through the National Plan and Provider Enumeration System (NPPES) as follows:
2.Paper:Fax application to 800/233-8641
Call or email NPPES at 800/465-3203 or PDSNPIUPDATE@Highmark.com. In January 2006, CMS issued an NPI Fact Sheet and identified other resources on the CMS website See also Medlearn Matters Number: MM4320.