Health Information Management

Tip of the week: Develop a plan now for NPI exchange

HIM-HIPAA Insider, March 27, 2007

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When the national provider identifier (NPI) final rule discusses making NPIs available to health plans and others from the National Provider and Plan Enumeration System, it uses the term "dissemination." But when the rule discusses the requirement for providers to give their NPIs to others who need it for transactions, it uses the term "disclose." This step of disclosure is important for all providers, as you want to continue to get paid for the medical care and service that you provide for your patients.

You need to send your corporate and subpart NPIs to all of your health plans. You will also need to give your NPIs to trading partners such as clearinghouses, third-party administrators, and, perhaps, your outsourced transcription business/individuals. This is the other side of the coin of collecting the individual provider NPIs so as to fill the HIPAA electronic transactions appropriately and use them as necessary on the UB-04 and on the new CMS 1500 claim form. Your health plans will ask you the same questions that you ask your individual providers.

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