The 1996 Health Insurance Portability and Accountability Act (HIPAA) established national privacy and security standards for electronic health care transactions, including a national identifier for providers, health plans and employers. Accordingly, by May 23, 2007, healthcare providers and all health plans and clearinghouses must change both their processes and information systems to implement HIPAA’s National Provider Identifier (NPI) regulations.

Background on the NPI regulation

  • HIPAA mandated regulation
  • Effective nationwide on May 23, 2007
  • The compliance date for health care payers with less than $5 million in annual revenue is May 23, 2008

What is the NPI?

  • A unique 10-digit identification number
  • Assigned for life to a provider and de-activated only upon death, retirement, or identity theft
  • Replaces multiple legacy provider identification numbers, including Medicare UPINs, commercial payer IDs and state Medicaid IDs
  • Contains no identifying information related to the provider - randomly generated
  • Independent of key provider information changes, such as practice location or specialty
  • Providers have 30 days to update their NPI record

Who is affected by the NPI mandate?

  • Payers
    • Health plans
  • Clearinghouses
  • Providers
    • Organizational providers
    • Individual providers

Why is the NPI necessary?

  • NPI delivers two-fold benefits for payers and providers:
    • Simplifies communication and administration
    • Facilitates efficient electronic transmission of certain health information
  • Streamlines detection of billing fraud and abuse
  • Improves debt collection efforts

What are the challenges of NPI implementation for payers and providers?

  • Providers and payers must exchange information
  • Technological implementation cost within organizations

What should payers and providers do now to prepare for the NPI?

  • Organize project teams to ensure a smooth transition
  • Identify and address processes and information system changes
  • Evaluate outsourcing solutions offered by technology vendors

Yuval Lirov, PhD, author of “Mission Critical Systems Management” (Prentice Hall), inventor of patents in Artificial intelligence and Computer Security, and CEO of Vericle.net Billing Technologies and Services. Vericle® unites hundreds of billing services across the nation. Its electronic medical billing software tracks payer performance from a single point of control and shares compliance rules globally. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

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