In Medical Billing there is a great deal of Medical Billing Terminology that can be intimidating to deal with when first getting started.

One important term that you must be familiar with is the National Provider Identifier (NPI).

The NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the unique physician identification number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers.

The NPI is the number assigned to covered healthcare providers that must be used by health plans and healthcare clearinghouses. HIPAA laws also require the use of this number.

How is the NPI used in Healthcare Billing?

– by health care providers to identify themselves in health care transactions identified in HIPAA or on related correspondence;

– by health care providers to identify other health care providers in health care transactions or on related correspondence;

– by health care providers on prescriptions (however, the NPI will not replace requirements for the DEA number or State license number);

– by health plans in their internal provider files to process transactions and communicate with health care providers;

– by health plans to coordinate benefits with other health plans;

– by health care clearinghouses in their internal files to create and process standard transactions and to communicate with health care providers and health plans;

– by electronic patient record systems to identify treating health care providers in patient medical records;

– by the Department of Health and Human Services to cross reference health care providers in fraud and abuse files and other program integrity files;

– for any other lawful activity requiring individual identification

How do Doctors signup for a National Provider Identifier?

The NPI number can be obtained online through the National Plan and Provider Enumeration System (NPPES). Turnaround time for obtaining a number is from 1 to 20 days.

NPI numbers can be searched on the CMS website.