FAQs - NPI
Identifier (NPI) Information
What is the National Provider Identifier (NPI)?
The Health Insurance Portability and Accountability Act (HIPAA)
of 1996 requires the adoption of a standard unique identifier for
health care providers. The NPI Final Rule issued January 23, 2004,
adopted the NPI as this standard.
The NPI is a 10-digit, intelligence-free numeric identifier
(10-digit number). Intelligence-free means the numbers do not carry
information about health care providers, such as the state in which
they practice or their provider type of specialization.
The NPI replaces health care provider identifiers in use today
in HIPAA standard transactions. Those identifiers include the
Indiana Health Coverage Programs (IHCP) provider number otherwise
known as the legacy provider identifier (LPI) and Medicare legacy
provider identifier such as the unique physician/provider
identification number (UPIN); Online Survey, Certification, and
Reporting (OSCAR); physician/provider identification number (PIN);
and National Supplier Clearinghouse (NSC).
The provider's NPI does not change and remains with the provider
regardless of job or location changes.
What is the purpose of the NPI?
The NPI is a single identification number assigned to health
care providers. It is intended to improve the efficiency of the
health care system and help to reduce fraud and abuse. The intent
of the NPI is to eliminate the need for payers and providers to
keep numerous identifiers and in turn simplify transaction
processing between entities.
Who is eligible for an NPI?
In order to get an NPI, a provider must be a health care
provider as defined under HIPAA. A "covered entity" is defined as a
health care provider, clearinghouse or health plan who conducts
standard electronic transactions. The Final Rule for NPI requires a
"covered entity" health care provider to get an NPI. These "covered
entities" must use the standards when conducting any of the defined
transactions covered under HIPAA. Covered entities are further
described as the following:
- Private sector health plans including:
- Managed care organizations (MCOs)
- Employee Retirement Income Security Act (ERISA) plans,
excluding some small self-administered health plans
- Government health plans including:
- State Medicaid programs
- Military Health System (for active duty and civilian
- Veterans Health Administration
- Indian Health Service programs
- Health care clearinghouses
- Health care providers that choose to submit or receive
With the exception of atypical providers, the IHCP requires all
health care providers (individual, organization, and subparts of an
organization) submitting electronic and paper claims to obtain an
NPI. Atypical providers conducting services like transportation or
carpentry are not considered health care services and therefore are
ineligible to get an NPI.
Who will issue NPI numbers?
The National Plan and Provider Enumeration System (NPPES) was
elected by the Centers of Medicare & Medicaid Services (CMS) to
assign the NPI to eligible health care providers. The NPPES also
stores the information about enumerated providers.
There is no cost to apply and providers may apply for an NPI in
one of three ways:
- Effective May 2005, providers may apply through an easy
web-based application process at the NPPES site.
- Effective April 2006, the electronic file interchange (EFI)
process, also referred to as "bulk enumeration", was made available
to providers. EFI allows a health care provider or group of
providers to have a particular electronic file interchange
organization (EFIO) apply for the NPI on their behalf. In other
words, rather than having a provider or group of providers submit a
paper or Web NPI application, the EFIO obtains an NPI for them via
the submission of an electronic file. More information on EFI can
be found at the CMS site.
- IHCP will not bulk enumerate on behalf of its providers.
Providers must furnish any updates to the NPPES within 30 days
of the change if any of the required data submitted on the
Will NPIs automatically be issued?
The Office of Medicaid Policy and Planning (OMPP) will not
conduct bulk enumeration for providers. If a provider wants to
obtain an NPI, the provider is responsible for either applying
directly for an NPI, or as part of another organization's bulk
How long does it take to obtain an NPI?
As reported on the CMS Web site, "We cannot predict the amount
of time it will take to obtain a National Provider Identifier (NPI)
because several factors come into play. Such factors include the
volume of applications being processed at a given time, whether the
application was submitted electronically or on paper, and whether
the application was complete and passed all edits. We expect that a
health care provider who submits a properly completed electronic
application could have its NPI in 10 days."
When will a provider begin using the National Provider
Identifier (NPI) on standard transactions?
Healthcare providers should be using the NPI on standard
transactions now. Before May 23, 2008, the Legacy Provider
Identifier (LPI) can also be submitted. Be sure to check remittance
advices (RAs) for any NPI-related explanation of benefit (EOB)
messages to ensure there is a successful NPI to LPI crosswalk.
Effective May 23, 2008, only your NPI can be submitted and there
must be a one-to-one NPI to LPI match or your claim or inquiry will
be rejected. Only atypical providers, those ineligible to receive
an NPI, are exempt from this deadline.
Will a provider's NPI ever change?
In most cases no. The following is a list of situations that
could occur for a covered entity with an NPI:
- If a health care provider is deceased, the NPI will be
- If a health care provider goes out of business, the NPI will be
- If a health care provider moves to a different geographical
location, it will not affect the NPI. The provider will maintain
the same NPI for life.
- If a health care provider's NPI is used in the case of fraud, a
new NPI will be issued.
Note: Deactivated NPIs will never be issued to other health care
If you do not process electronic transactions, do you need an
Yes. The IHCP requires all health care providers (individual,
organization, and subparts of an organization) who provide health
care services and submitting electronic or paper claims to obtain
Do you need to use the NPI when billing claims?
Yes. If you are required to have an NPI for other transactions,
you must also use it for billing claims.
Do we have to get a different NPI for each service
No. The same NPI can be reported for different service
locations; however, if the same NPI is reported, there must be a
different taxonomy or zip code+4 reported for the various
What is the definition of an atypical provider and how will HP
handle those transactions?
An individual or business that is not a health care provider and
does not meet the definition of a health care provider according to
the NPI Final Rule (e.g., carpenters, non-emergency transportation
providers, and so forth).
HP will continue to identify providers that are not eligible for
an NPI with their LPI.
Can an atypical provider send standard transactions
Yes, an atypical provider such as a non-emergency transportation
provider may use electronic data interchange (EDI). Using EDI does
not determine if the provider is providing health care services or
not. Since a transportation provider cannot get an NPI, the current
LPI must be used.
Whom do I contact if the NPI Reporting Tool shows a rendering
provider that is no longer in my group?
Contact the Provider Enrollment and Waiver Line at
1-877-707-5750 or write to:
HP Enterprise Services
Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263
Whom do I call if I am having trouble with my password for the
Call the EDI Solutions Help Desk at (317) 488-5160 in the
Indianapolis local area, or 1-877-877-5182.
Whom do I call for all other questions about the NPI Reporting
Call Customer Assistance at (317) 655-3240 in the Indianapolis
local area, or 1-877-577-1278.
How do I request a paper NPI application from the enumerator by
Call the National Plan and Provider Enumerator System (NPPES) at
1-800-465-3203 to request the paper form. Or, download the CMS form
10114. Mail the completed form to:
P.O. Box 6059
Fargo, ND 58108-6059
What standard transactions are affected by HIPAA?
As required by HIPAA, the Secretary of Health and Human Services
is adopting standards for the following administrative and
financial health care transactions:
- Health claims and equivalent encounter information
- Enrollment and disenrollment in a health plan
- Eligibility for a health plan
- Health care payment and Remittance Advice
- Health plan premium payments
- Health claim status
- Referral certification and authorization
- Coordination of benefits
Standards for the first report of injury and claims attachments
(also required by HIPAA) will be adopted at a future date.
Where may I obtain Implementation Guides for standard
Implementation Guides are available from the CMS or from Washington Publishing
Where may I find additional NPI information from CMS?
To get additional information to to the CMS
What is the link to the NPI application process on the CMS Web
To apply for an NPI through the Internet, go to the NPPES Web
Multiple NPIs or
What are subparts?
Organization providers may have the option to obtain more than
one NPI. Some components or subparts of an organization may be
eligible to obtain separate NPIs. The following are examples of
- Certified separately
- Licensed separately by the State
- Required by Federal Regulations to have their own billing
- IHCP Subpart
Subparts do not apply to individual providers. Only a provider
can determine whether they need to apply for multiple IDs or
subpart the provider's organization.
Additional information about the types of providers and subparts
may be obtained from the Web sites of the CMS site or the NPPES Web site.
NPI Reporting Tool
What is the NPI Reporting Tool (Web tool)?
The NPI Reporting Tool is a Web-based application that allows
providers to report their NPIs to the IHCP.
What date will the NPI Reporting Tool be available?
The NPI Reporting Tool is scheduled to be available on September
Is information that you input using the NPI Reporting Tool
updated in real-time or in batch mode?
The information you enter into the NPI Reporting Tool is updated
Will the NPI Reporting Tool be the only way to report your
No. You can request a paper NPI Reporting Form to report your
NPI. Using the tool is quicker and more efficient. However, if you
want to use a paper application, instructions will accompany your
notification letter. When the NPI Reporting Form is received, HP
will enter the information into the system from the paper
How will rendering providers report their NPI to the IHCP?
Groups are required to obtain NPIs from their rendering
providers and report them to the IHCP on the rendering providers'
How do we remove rendering providers from our group using the
NPI Reporting Tool?
If the NPI Reporting Tool identifies a rendering provider that
is no longer in your group, contact the Provider Enrollment and
Waiver line at 1-877-707-5750 to request an IHCP Provider
Termination Form or download the
form from the IHCP Web site.
The IHCP Provider Termination Form must be completed, signed,
dated, and mailed to:
HP Enterprise Services
Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263
Will the rendering providers who are linked to the group,
Yes. When a group logs into the NPI Reporting Tool, all active
rendering providers affiliated with the group are accessible under
each group's service locations. Groups are required to obtain the
NPI from their rendering providers and report it to the IHCP on the
rendering providers' behalf.
Can you do anything besides reporting your NPI on the NPI
No. You can only report your NPI and associate your Taxonomy
codes utilizing this tool.
Can a rendering provider's NPI be reported without reporting
the group in the NPI Reporting Tool?
No. Groups are required to report the NPI of their rendering
providers and they are required to report their NPI before they can
gain access to the screen that allows them to report their
How do I correct errors made on the NPI Reporting Tool?
Once an entry is submitted using the NPI Reporting Tool, all
changes require HP intervention. You must contact Provider
Enrollment at 1-877-707-5750.
How do I update our address in the NPI Reporting Tool?
If address information is incorrect in the NPI Reporting Tool,
you can download and complete the Name Address
Maintenance form or go to Web interChange to change service
How can I tell if the NPI was successfully reported in the NPI
In each provider subsection of the NPI Reporting Tool, the
provider number (nine-digit number) and the service location code
(alpha character) displays in the green, red, or blue header, and
the status of the provider/service location/NPI record. Before any
NPI is reported the header will be Blue (not reported), an
unsuccessful entry will be Red (conflict), and a successfully
reported NPI will have a Green (Active) header.
Can I fax the NPI Reporting Form instead of mailing it?
No. The NPI Reporting Form must be completed, signed, dated, and
HP Enterprise Services
Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263
Can I report my NPI over the phone?
No. A provider's NPI can be reported using the NPI Reporting Tool.
Can we enter more than 15 taxonomy codes?
No. The NPI Reporting Tool will only allow a user to enter 15
Do I have to report my NPI using the online tool and the paper
No. Use only one method, either the paper form or the online NPI
Reporting Tool. You do not need to use both. Best is the online
tool, since it will print an immediate receipt to confirm the
proper reporting of your NPI.
Do I need to report the NPI if the physician is deceased?
If a physician is deceased, and claims or adjustments will be
submitted on his behalf on or after May 23, 2008, an NPI must be
reported for the physician.
Do we have to report an NPI for all provider locations?
Yes, every service location submitting claims for services by a
healthcare provider must have an NPI reported if you plan to bill
Medicaid after the final compliance date.
Do we have to report contact information for each provider
No. Contact information is required only once for each time a
user logs into the system to report NPIs. If a user logs out of the
system and logs back in, contact information will be required.
Do we have to report our NPI if we do not file electronic
Yes. The NPI will be required on both electronic claim
transactions and paper claims transactions.
Do we have to report our NPI to the MCOs?
Providers must contact the
MCO with whom they are affiliated to find out what their NPI
solution will involve.
If a provider is no longer part of our practice, do we still
need to report their NPI if they are showing up on the tool?
If transactions will continue to be submitted for the departed
practitioner by the practice on or after May 23, 2008, it is
necessary to report the provider's NPI.
If I don't know the NPI for all of our rendering doctors, can I
go back and report them later?
Yes. You can log back into the NPI Reporting Tool at any time to
report the NPI for providers.
Where do I put my NPI number on the claim form?
Providers should refer to the appropriate paper claims bulletin
listed on the IHCP website. The bulletins provide detailed
information on the various claim form fields.
Related Web Sites
Where may I learn more about NPI?
Medicare NPI policy and recommendations are
available on the CMS Web site.
Where may I learn more about the NPI Application and
Information about NPI Application and Enumeration is available
from the NPPES Web site.
Standard Transactions (Claims,
If a batch of claims is submitted and one is missing the NPI,
will the batch be rejected?
No. The batch will be accepted, but effective May 23, 2008, the
individual claim with the missing NPI will not.
Do I have to bill the rendering NPI on the claims
Yes. The rendering NPI will be required on claims
What is the definition of a Taxonomy code?
The health care provider Taxonomy code is a unique, 10-digit,
alphanumeric code that allows a provider to identify a specialty
category. Providers applying for an NPI are required to submit
their Taxonomy codes. Providers may have one or more Taxonomy codes
associated to them. Waiver providers are not required to enter
their Taxonomy codes when reporting their NPI to the IHCP.
Does the Taxonomy code need to be reported on claims?
The taxonomy code is used for the NPI to LPI crosswalk and is
needed only when a provider with multiple billing provider office
locations share a single NPI, and one or more billing provider
office locations are within the same ZIP Code + 4.
Where will the NPI and Taxonomy code be reported on the
A copy of the revised claim form can be found on the National Uniform Claim
Committee Web site at http://www.nucc.org. The billing provider
NPI is reported in form locator 33a and the taxonomy code, with
qualifier ZZ, in 33b. The rendering provider NPI is reported in the
bottom half of 24J, the taxonomy code is reported in the top half
of 24J. Qualifier ZZ, which indicates Taxonomy code, should be
reported in the top half of 24I.
Do I use my LPI or my NPI on claims with a date of service on
or after the final compliance date?
Regardless of the date of service, any claim received on or
after May 23, 2008, must use the NPI.
Providers and other Atypical Providers
Q: Are all waiver providers atypical?
Not all waiver providers are atypical providers. Workgroup for
Electronic Data Interchange (WEDI) developed a white paper that may assist in determining
an atypical provider.
Directory of Other
Q: Will HP offer a directory of NPIs for other providers?
No. NPPES provides an online NPI Registry. Users may
search the registry by NPI or legal business name.