November 3, 1999 HIPAA Announcement:

New HIPAA Standard for NPI (National Provider Identifier)

01/22/04

Today, the Centers for Medicare & Medicaid Services (CMS) announced the adoption of the National Provider Identifier (NPI) as the standard unique health identifier for health care providers to use in filing and processing health care claims and other transactions. The Final NPI rule will be published on January 23. The effective date of this Rule will be May 23, 2005.

The standard unique health identifier is mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NPI is a new number that will be issued through the National Provider System, which is being developed by CMS. The NPI replaces all “legacy” identifiers that are currently being used. All health care providers, whether or not they are covered entities under HIPAA, are eligible to be assigned NPIs. Non-covered providers may obtain NPIs.

All covered health care providers must obtain NPIs. Health care providers are covered entities if they transmit any data in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard. Covered entities must use NPIs in standard transactions no later than the compliance dates. The compliance dates for all but small health plans is May 23, 2007 . The compliance date for small health plans is May 23, 2008.

A health care provider will be assigned only one NPI, and that NPI will not change over time. Adoption of the standard health care provider identifier enables a provider to use only one identifier – the NPI – to identify her/him/itself in all (HIPAA) standard transactions.

Health care providers do not need to take any action to apply for NPIs at this time. The system that will handle the assignment of NPIs will be ready to accept applications for NPIs after the effective date of the final rule, which is May 23, 2005. Health care providers may begin applying for NPIs on that date. CMS will provide the health care industry with information relating to the NPI, including the application process and the availability of the NPI application forms, closer to the effective date.

In Summary:

January 23, 2004 – Publish date of final NPI Rule.

May 23, 2005 - Effective date of the NPI Rule.

May 23, 2007 – NPI Rule compliance date for all but small health plans.

May 23, 2008 – NPI Rule compliance date for small health plans.