| The 1996 Health Insurance Portability and | | | | changes, such as practice location or specialty |
| Accountability Act (HIPAA) established national | | | | - Providers have 30 days to update their NPI |
| privacy and security standards for electronic | | | | record |
| health care transactions, including a national | | | | Who is affected by the NPI mandate? |
| identifier for providers, health plans and employers. | | | | - Payers |
| Accordingly, by May 23, 2007, healthcare | | | | - Health plans |
| providers and all health plans and clearinghouses | | | | Clearinghouses |
| must change both their processes and information | | | | Providers |
| systems to implement HIPAA's National Provider | | | | - Organizational providers |
| Identifier (NPI) regulations. Background on the NPI | | | | - Individual providers |
| regulation | | | | Why is the NPI necessary? |
| - HIPAA mandated regulation | | | | - NPI delivers two-fold benefits for payers and |
| - Effective nationwide on May 23, 2007 | | | | providers: |
| - The compliance date for health care payers with | | | | - Simplifies communication and administration |
| less than $5 million in annual revenue is May 23, | | | | - Facilitates efficient electronic transmission of |
| 2008 | | | | certain health information |
| What is the NPI? | | | | Streamlines detection of billing fraud and abuse |
| - A unique 10-digit identification number | | | | Improves debt collection efforts |
| - Assigned for life to a provider and de-activated | | | | What are the challenges of NPI implementation for |
| only upon death, retirement, or identity theft | | | | payers and providers? |
| - Replaces multiple legacy provider identification | | | | - Providers and payers must exchange |
| numbers, including Medicare UPINs, commercial | | | | information |
| payer IDs and state Medicaid IDs | | | | - Technological implementation cost within |
| - Contains no identifying information related to the | | | | organizations |
| provider - randomly generated | | | | What should payers and providers do now to |
| - Independent of key provider information | | | | prepare for the NPI? |