National Provider Identifier

National Provider Identifier (NPI) Information

Applying for the National Provider Identifier

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for healthcare providers. The final rule for the NPI was issued on January 23, 2004, and adopts the NPI as this national standard.

Healthcare providers can apply now for their NPI at the following website: https://nppes.cms.hhs.gov. All HIPAA-covered physicians, suppliers, and other health care providers must apply for and be issued an NPI by May 23, 2007. In addition, all health plans must be able to accept the NPI instead of the plan-specific provider identifiers on all HIPAA standard transactions by May 23, 2007. In other words, after this date, claims submitted to Medicaid must be billed with your NPI number instead of your current Medicaid provider number.

ALERT: When applying for an NPI, you are urged to include all Medicaid provider numbers on the NPI application form. Be sure to indicate North Carolina as your state name. It is our understanding that at some point CMS will make enumeration information available to states. AT that time, this information will assist DMA in the development of crosswalks between your NPI and your Medicaid provider numbers.
(June 2006 General Medicaid Bulletin)

NPI Collection Efforts

Beginning September 1, 2006, the NC Medicaid Program will begin collecting the National Provider Identifiers (NPI) from currently enrolled Medicaid providers. The NC Medicaid NPI form will be published in the September general Medicaid bulletin and will also be available on the DMA's website at http://www.dhhs.state.nc.us/dma/NPI.htm. The form can be returned by fax or mail to the address listed on the form. Providers must also include with the NPI form a copy of the notification letter form the National Plan and Provider Enumeration System (NPPES).

DMA is pursuing options for e-mail. web-based and electronic batch submission. Details will be provided in future bulletins.

Providers are encouraged to apply for their NPI immediately. Please go to the website https://nppes.cms.hhs.gov. Please indicate North Carolina as your state name and include your Medicaid provider number(s). Claims submitted after May 23, 2007 will deny without an NPI number.

Remember, applying for an NPI does not replace any enrollment or credentialing processes for NC Medicaid.
(August 2006 General Medicaid Bulletin)

Email Page Print Page