As of May 23, 2007, all American physicians will need to be in possession of a new National Provider Identifier (NPI). This new number will replace all previous identifiers and be used commonly for all communications, written and electronic with all payers: Medicare, Medicaid, private insurance groups and others. It must be used by all entities under HIPAA (health plans, health care clearinghouses and health care providers that conduct standard transactions). It must be used for "standard transactions" including claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance notices. The goal is to replace the many different identifiers currently in use with one, single, national, unique code that will simplify future communication and make it more secure.

While it will take 2 years to fully phase in this new system, physicians may begin the application process May 23, 2005. However, the health plans and clearinghouses have up until May 23, 2007 to accept the new identifiers. Since we expect various entities to begin to require its use earlier than that, it benefits physicians to obtain their number as early as possible. Do not begin to use your new NPI until the health plan you are doing business with notifies you that they are ready for it. Since many different entities will require its use, you may be confused by notifications from each of them that seem duplicative. You only need to apply once to receive a single NPI that each will recognize in the future.

The NPI can be obtained in one of three ways
(only choose one of these):

1. A Web-based application process will be available starting May 23, 2005 but not until that date.
The web address is https://nppes.cms.hhs.gov.

2. Beginning July 1, 2005, a paper application form will be available from https://nppes.cms.hhs.gov or by calling the intermediary responsible for processing the application (Fox Systems, Inc) at 1-800-465-3203. This paper application can not be submitted until July 1, 2005.

3. With your permission, any organization such as an employer could submit your application for you in an electronic file. This process will become available in the fall of 2005.

Obviously, the electronic format will be the easiest and quickest. The NPI could be issued within minutes if all information is correct and without problems.

You can expect to hear much more about this process in the next couple of years. Do not be confused by repeated, duplicate announcements from different sources. You need only apply and be provided your new NPI once. Do not begin to use it until you are notified by your specific business partner. We will keep you posted on related developments as they are published.