N ational P rovider I dentifier Type 1 Workforce Training

1. National Provider Identifier Type 1Workforce Training Month Day, Year The NPI will become the standard, unique identifier for health care providers in HIPAA Transactions

2. Purpose • This training presentation is being delivered to educate workforce members on • National Provider Identifier Requirement • How to Obtain an NPI • How to Report NPI to Facility/Division • NPI Resources Available DHHS/DIRM Projects Office - NPI Initiative

3. National Provider Identifier Requirement DHHS/DIRM Projects Office - NPI Initiative

4. Background • The NPI is a HIPAA Administrative Simplification Standard • Transactions and Code Sets • Security • Privacy • Identifiers • Unique Employer Identifier • Unique Health Care Provider Identifier (NPI) • Unique Health Plan Identifier – Proposed rule pending DHHS/DIRM Projects Office - NPI Initiative

5. NPI Final Rule • Published January 23, 2004 • Requires the use of the NPI in standard transactions to identify health care providers standard transactions no later than 5/23/07 • Replaces the use of proprietary and legacy provider identifiers in standard transactions • Unique Physician Identification Number (UPIN) • Medicaid ID • Medicare ID • BCBS, Aetna, etc. IDs DHHS/DIRM Projects Office - NPI Initiative

6. NPI Final Rule – cont’d • Placed requirements on HIPAA covered entities • Health plans (e.g., Medicare, NC Medicaid, BCBS) • Health care clearinghouses • Health care providers conducting HIPAA standard transactions • DMH/DD/SAS facilities • DPH State Lab and CDSAs • OES Schools DHHS/DIRM Projects Office - NPI Initiative

7. Who Must Get an NPI? • All health care providers who conduct any of the HIPAA standard transactions • Individuals – NPI Type 1 • These individuals furnish health care services that are billed using HIPAA standard electronic transactions or may initiate and / or receive referrals. This includes: • DHHS Workforce Members • Private Providers • Organizations – NPI Type 2 • Organization “Subparts” – NPI Type 2 • Components of organizations that conduct transactions separately from the rest of the organization • Note – all “health care providers” as defined by 160.103 are eligible for NPI DHHS/DIRM Projects Office - NPI Initiative

8. Who Must Get an NPI in This Facility? • List Provider Types Here DHHS/DIRM Projects Office - NPI Initiative

9. What is an NPI? • 10 digit number • All numeric • Never changes • Good for the life of the provider • May be deactivated/reactivated • Does not itself convey information about the provider • Legacy provider numbers may have “intelligence” that describes the provider type, specialty, and location DHHS/DIRM Projects Office - NPI Initiative

10. Who Assigns NPIs? • NPI Enumerator – HHS contracted with Fox Systems, Inc. • Process applications and assigns NPIs • Maintains NPI data in the National Plan and Provider Enumeration System (NPPES) • Furnishes NPI information upon request and in accordance with established guidelines • Privacy Policy available at https://nppes.cms.hhs.gov/ DHHS/DIRM Projects Office - NPI Initiative

11. DHHS Approach to Workforce Enumeration • DHHS HIPAA Oversight Committee Recommendation • DHHS not assume the responsibility to submit NPI applications for workforce members • Memo sent to DHHS Division Directors April 2006 (http://hipaa.dhhs.state.nc.us/hipaa2002/identifiers/identifiers.html) • DHHS Policy under development to support decision DHHS/DIRM Projects Office - NPI Initiative

12. Requirements for DHHS Workforce • DHHS workforce members must • Apply for NPI by schedule required by facility/division • Report NPI data to facility/division NPI Contact • Maintain data supplied to obtain NPI changes • Updates to be made within 30 days of change • Report appropriate changes to facility/division NPI Contact DHHS/DIRM Projects Office - NPI Initiative

13. How to Obtain an NPI DHHS/DIRM Projects Office - NPI Initiative

14. Before You Apply • Collect the following information • SSN or Individual Taxpayer Identification Number • Date of Birth • Country of Birth • State of Birth (if Country of Birth is U.S.) • Gender • Mailing Address • Practice Location Address and Phone Number • Taxonomy Code(s) • State License or Certification Information (required for certain Taxonomy Codes) • Contact Phone Number and Email Address DHHS/DIRM Projects Office - NPI Initiative

15. Taxonomy Codes Explained • An additional, unique, 10 position number to be listed on NPI application • Minimum of one required; up to 14 allowable • Some require license/certification number • Provides additional information on provider (replaces missing legacy ID “intelligence”) • Provider Type • Classification • Area of Specialization • Situational use on transactions – requirement TBD by each health plan • DHHS assuming all plans will require • Taxonomy Code list available atwww.wpc-edi.com/taxonomy • Use “Individual or Groups (of Individuals)” list DHHS/DIRM Projects Office - NPI Initiative

16. Taxonomy Codes – cont’d DHHS/DIRM Projects Office - NPI Initiative

17. How to Apply • Two options available at https://nppes.cms.hhs.gov/ • Paper Form • Make a copy before mailing • Keep notification letter of assigned NPI • Electronic Form – Recommended • Self-assigned ID and Password – store in safe place • Print every page before advancing • Keep notification email of assigned NPI • Helpful HINT: Review CMS NPI Viewlet before applying! • http://www.cms.hhs.gov/apps/npi/npiviewlet.asp DHHS/DIRM Projects Office - NPI Initiative

18. How to Report NPI Data to Facility/Division DHHS/DIRM Projects Office - NPI Initiative

19. What to Report • Provide a copy of the NPI assignment letter/email • Include Taxonomy Code(s) listed on application • Give to NPI Contact designated by your Facility or Division DHHS/DIRM Projects Office - NPI Initiative

20. Your NPI Contacts Are • Name • Phone • Email Address • MSC Code • Name • Phone • Email Address • MSC Code DHHS/DIRM Projects Office - NPI Initiative

21. Reporting Schedule • Facility/Division Schedule to be inserted here DHHS/DIRM Projects Office - NPI Initiative

22. NPI Resources Available DHHS/DIRM Projects Office - NPI Initiative

23. NPI Resources • Centers for Medicare and Medicaid Services (CMS) • http://www.cms.hhs.gov/apps/npi/01_overview.asp • DHHS HIPAA Web Site • http://hipaa.dhhs.state.nc.us/hipaa2002/identifiers/identifiers.html • Contains Helpful Hints, FAQs, and other useful information DHHS/DIRM Projects Office - NPI Initiative

24. NPI Resources – cont’d • NPI Enumerator • https://nppes.cms.hhs.gov/ • customerservice@npienumerator.com • 1-800-465-3203 or TTY 1-800-692-2326 • Can provide copies of NPI notification letter if lost DHHS/DIRM Projects Office - NPI Initiative