National Provider Identifier

A National Provider Identifier (also known as an NPI) in a custom identification numbers with ten digits. This number is issued to health care providers and professionals in the U.S. by the Centers for Medicare and Medicaid Services (also known as CMS). NPIs are now the standard, having replaced the unique physician identification number (also known as UPIN) as the main way to identify providers for Medicare services. It can be used by payers such as commercial healthcare insurance companies.

Entities that are covered by HIPAA are required by U.S. regulation to only use the NPI to identify covered healthcare providers. These entities can include providers who utilize electronic transactions, clearinghouses, and health plans. Under HIPAA, all health care providers, plans, and clearinghouses have to use NPIs in their transactions.

There are also additional optional uses for NPIs:

  • To identify providers in health care transactions.

  • To identify other providers on a related correspondence.

  • To submit subscriptions.

  • To allow health plans to process transactions in their internal provider files, as well as communicate with providers.

  • To coordinate benefits with additional health plans.

  • To help clearinghouses use their internal files to process transactions and communication with providers and plans.

  • To allow electronic patient record systems to identify providers in medical records.

  • To help the Department of Health and Human Services cross-reference providers in fraud or mistreatment files.

  • To aid in legal activities that require identification of individual providers.

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