What is NPI registry? Industry jargon can be a challenge for those new on the scene and those with experience operating within it while fresh terms are coined and new acronyms appear frequently. Hospitals and healthcare facilities operate within strict regulations for compliance, and missteps have consequences.
In this article, we cover the NPI Registry, what it means, what its purpose is, how to look yourself or your facility up, and how to apply to be on it if you aren't already but need to be. Let's start with getting a few acronyms straight.
Relevant Acronyms
- NPI stands for National Provider Identifier
- NPPES stands for National Plan and Provider Enumeration System
- CMS stands for Centers for Medicare & Medicaid Services
- HIPAA stands for Health Insurance Portability and Accountability Act
FAQs About NPI Registry
1. What is the NPI Registry?
The NPI Registry is a free database developed and maintained by CMS that allows you to search for providers or plans in the NPPES. The registry serves to "publish the parts of the NPI record that have public relevance, including the provider's name, specialty (taxonomy), and practice address."
2. What is an NPI Number?
NPI number is the standardized identification for healthcare providers, which is federally mandated. By using NPIs, healthcare partners and payers can identify you during HIPAA standard transactions. NPI numbers are generated for free by the NPPES and searchable through the NPI Registry. There are two categories of NPI numbers: type 1, which is for individuals, and type 2, which is for organizations.
3. What are HIPAA Standard Transactions?
Electronic healthcare information exchanges related to services, payments, or other administrative tasks can be considered HIPAA standard transactions. Common examples of HIPAA standard transactions include the following:
- Payment and remittance advice
- Claims status
- Eligibility
- Coordination of benefits
- Claims and encounter information
- Enrollment and disenrollment
- Referrals and authorizations
- Premium payment
4. Are You Required to Have an NPI?
Healthcare providers or entities bound by HIPAA compliance are required to have an NPI; for terminology purposes, these persons or organizations are called "covered entities." Covered entities can include health plans, clearinghouses, and providers.
You or your organization is considered a health plan requiring an NPI if any of the following apply:
- "Health insurance companies
- HMOs, or health maintenance organizations
- Employer-sponsored health plans
- Government programs that pay for health care, like Medicare, Medicaid, and military and veterans' health programs."
You or your organization is considered a clearinghouse requiring an NPI if you "process nonstandard health information to conform to standards for data content or format, or vice versa, on behalf of other organizations."
You or your organization is considered a provision requiring an NPI if you submit HIPAA transactions that can include (but are not necessarily limited to) the following professions:
- Doctors
- Clinics
- Psychologists
- Dentists
- Chiropractors
- Nursing homes
- Pharmacies
If you're still uncertain whether you or your organization is required to have an NPI number, the CMS created a decision tool to help you find the correct answer, Covered Entity Decision Tool. Obtaining an NPI is a federal requirement if you are considered a covered entity; it is also free of cost.
5. How Can You Apply for an NPI Number?
The CMS offers three ways to apply for an NPI:
- "Complete the online application at the NPPES website;
- https://NPPES.cms.hhs.gov/NPPES/Welcome.do;
- Download the paper application form at www.cms.hhs.gov/NationalProvIdentStand/
- and mail it to the address on the form; or,
- After asking you for your permission, authorize an employer or other trusted organization to obtain an NPI for you through bulk enumeration or Electronic File Interchange (EFI)."
6. Do you Already Have an NPI Number?
What if you think you already have an NPI number but aren't sure or don't know what it is? You can look up your NPI number by using the NPI Registry to do a public search. Review the search criterion options on the registry carefully; search results are limited to 2,100, so the more information you have, the easier to filter results.
7. Can You Have More than One NPI Number?
Individuals can only have one NPI number assigned to them. Alternatively, organizations may have more than one NPI number assigned, perhaps based on their different systems or departments.
8. Will My NPI Number Ever Change?
No. Your NPI number is unchangeable, regardless of any changes you make to your name, address, taxonomy, etc. However, you can update your NPI account with those changes online. For deactivation or reactivation of your NPI, a paper form is required.
