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National Provider Identification Number (NPI)

National Provider Identification (NPI) is the standard ten-digit unique health identifier for health care providers that has been adopted as a result of HIPAA to replace the various legacy numbers, UPINs, Medicaid numbers and other proprietary numbers that health care entities or health plans have assigned to health care providers. For Medicare and Medicaid programs, NPI will hopefully be the tool that standardizes the national health care provider identification system which will also be accepted by health plans, clearinghouses, etc.

You may apply for an NPI on-line; it is free and will be operational about 120 days after you receive it. You may call the NPI Enumerator Call Center at (800) 465-3203 if you have questions. Visit National Provider Identifier Standard from CMS and the US Department of Health & Human Services for more information on NPI with downloads and other related links.

Facts you should know....

  • By May 23, 2007, all health plans must accept and use NPIs to identify providers in transactions involving claims, eligibility, referrals, and remittance advices.
  • IMS is prepared to record your NPI in our system to assist our clients with the HIPAA mandate. Providers must still include their tax identification number on claims for 1099 purposes.
  • After May 23, 2007, clean claims received by IMS that are submitted electronically through which do not include an NPI number will still be reprice; however, your clearinghouse or the payor may reject the claim without your NPI number, until submitted with your NPI number.
  • Contractually, IMS Participating Providers are required to maintain current demographics and any other pertinent information (including but not limited to your NPI number) required by us to operationalize, manage, and adjudicate any services rendered.

NPI and any other identifying information shared with us will be held in the strictest of confidence and is allowed to be shared as it pertains to billing, adjudication and payment activity for claims.

You can register your NPI online, by phone or fax with IMS. Please contact IMS Provider Relations at 800-853-7003 or click here to use the provider update form to register it online now.

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