A Quick Guide to Understanding NPI Numbers

Previously, the medical fraternity had numerous identification numbers that were used to file claims, during billing, and to perform other medical transactions. What it did was complicate and delay billing processes, among other things. To make the workload easier and serve medical employees faster, the United States government unveiled National Provider Identifier (NPI) numbers.

Physician

What is an NPI number?

NPI number is a set of 10 unique digits that are used in the identification of medical practitioners in the United States. The number is not only used by individuals but also healthcare entities. It is adopted under Health Insurance Portability and Accountability (HIPPA) and is mandatory for all covered healthcare professionals.

Submitting an NPI Application

Signing-up for the NPI number is done online. It requires a medical practitioner to apply through the National Plan and Provider Enumeration System (NPPES).

NPPES is one of the quickest ways that providers can get an NPI number. The body is also responsible for handling all queries and matters regarding the NPI application. Whether you want to update your information or deactivate your NPI, NPPES will sort you out.

After application, your NPI number is ready within the month. To know if you are registered, the NPPES lookup service comes in handy.

What you need to note, however, is the fact that a successful application is not proof that the medical practitioners if licensed. Such data is available with the various licensing boards, among other critical sources of data.

NPPES Lookup

NPPES lookup is a service that allows you to check if you have a registered NPI number. A successful search can either display the NPI number. The number must also be accompanied by the name of the individual or healthcare entity.

Reasons to take an NPI number

All medical practitioners and healthcare entities that conduct transactions that fall under the HIPPA act require the NPI number. The same applies to physicians and institutions that process their claims through a medical billing company as well as those that submit patient information electronically during a transaction.

In all the above scenarios, the NPI number is essential as it facilitates the processing of HIPPA standard transactions. There will also be efficient coordination during the processing of benefits, among other things.

Additionally, the NPI number is needed for identification purposes in a process that involve the claiming of insurance benefits.

People and organizations that require the NPI number include:

  • Nurses
  • Physicians
  • Medical equipment suppliers
  • Pharmacists
  • Dentists
  • Healthcare clearing houses
  • Healthcare plans
  • Opticians
  • Hospitals

The above is not an exhaustive list of medical providers that need NPI numbers. To check whether or not you fall under this category, the internet offers an invaluable resource.

Conclusion

All providers need to understand that the NPI number is unique and does not change even when they change jobs or receive job promotions. Its importance goes so far that a missing or incorrect NPI number is one of the main causes of denied or delayed claims.