National Provider Identifier

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required the adoption of a standard unique identifier for healthcare providers. The National Provider Identifier (NPI) Final Rule issued January 23, 2004, adopted the NPI as this standard.

The NPI is a 10-digit numeric identifier that is required for almost all providers - both individuals and organizations - that want to enroll in the Indiana Health Coverage Programs (IHCP). NPIs are intended to improve the efficiency of the healthcare system and help reduce fraud and abuse.

Some providers, such as waiver providers and most transportation providers, are not healthcare providers per se. These providers are called atypical providers and are not required to have NPIs. To do business with the IHCP, however, atypical providers must have IHCP Provider IDs (formerly Legacy Provider Identifiers, or LPIs), which they receive when they enroll as IHCP providers.

A provider's NPI does not change and remains with the provider regardless of job or location changes. Having an NPI does not:

  • Ensure that a provider is licensed or credentialed
  • Guarantee payment by a health plan
  • Enroll a provider in a health plan
  • Turn a provider into a covered provider
  • Require a provider to conduct HIPAA transactions

GETTING YOUR NPI

The National Plan and Provider Enumerator System (NPPES) assigns NPIs. To get an NPI, providers may apply at the NPPES website.

Providers need to obtain NPIs in order to submit their IHCP provider enrollment application. When providers apply for NPIs, they must supply information such as the provider's business name and address, date of birth, Social Security number, or employer tax ID.

Providers are also asked to choose taxonomy codes that describe their provider type and specialty, and supply associated license numbers as part of the enumeration process.

After receiving their NPIs, providers must report their NPIs to the IHCP.

REPORTING an NPI

Providers can report their NPIs to the IHCP, or update existing NPIs, via the Provider Healthcare Portal when they enroll online.

Healthcare service providers must use the NPI on claims - not the IHCP Provider ID. Nonhealthcare service providers - also known as atypical providers - must use their IHCP Provider IDs on claims. For all other submissions and communication, all providers should refer to the IHCP Provider ID. A provider's claims submitted without an NPI, or an IHCP Provider ID if you are an atypical provider, will be rejected.

NPI Default INFORMATION

An NPI default location may be needed when an entity has multiple IHCP Provider IDs but only one NPI.

If you enroll in the IHCP via the IHCP Provider Healthcare Portal, you can designate one of your billing provider locations as your NPI default location. If you enroll in the IHCP using paper, you must complete the IHCP NPI Default Agreement to select the default NPI location. Please note that all claims billed with your NPI will default to the one location you choose.

For claims to process correctly, group providers must ensure that all their rendering practitioners are linked to the default location on record with the IHCP. Rendering providers must be linked to each service location where they render services as well as to the default NPI location. For more information about enrolling in the IHCP, see the Provider Enrollment provide reference module.

Additional INFORMATION

See the following sources for more information about NPIs:

National Plan and Provider Enumerator System (NPPES)

NPI Web Application Site

Centers for Medicare & Medicaid Services (CMS)

NPI Overview

Are You a Covered Entity?

NPI Enumerator Address

NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059
1-800-465-3203
1-800-692-2326 (TTY)

Email Customer Service