Durham Dada's Blog

Doctors and other health care providers who follow Healthcare News know by now to have a National Provider Number. Also known as the National Provider Identifier (NPI), this ten-digit number can be used across the nation and for life. It replaces all the other identifying numbers that health care providers once used. These include the Unique Physician/Practitioner Number and the Blue Cross and Blue Shield Numbers. It is also meant to replace the use of the Medicare and Medicaid Provider numbers. The use of the national provider number is mandated by the Healthcare Legislation known as the Health Insurance Portability and Accountability Act of 1996.

Because of this legislation, health care providers, health plans, and clearing houses were required to obtain a number, rather than wait for the states to assign an identifying number to them. All the providers of health care covered by the legislation were required to get an NPI so that they can identify themselves properly in transactions. Such transactions include questions and replies regarding eligibility and claim status, and advice regarding payment and remittance. They also include drug claims by hospitals, medical and dental practices, and retail pharmacies. All health care providers, whether they submit claims on paper or through the Internet are required to register their national provider number with the Department of Public Works.

It’s not all that difficult to get a national provider identifier number. Providers only need to to the website of the National Provider and Plan Enumeration System to obtain it.