Every licensed physician, healthcare provider, or organization possesses a National Provider Identifier or NPI. So, what are NPI numbers, and who can use them?
What are NPI Numbers?
National Provider Identifier, or NPI, helps to identify a healthcare provider. This is particularly relevant in standard transactions like health care claims. NPI also helps to identify healthcare professionals in prescriptions, health plans, and so on.
There is a National Plan and Provider Enumeration System (NPPES) that acts as a centralized database. It creates and manages the Centers for Medicare and Medicaid Services (CMS). They also assign NPIs which enable the efficient transmission of health information electronically.
How Are NPIs Attained?
Healthcare providers are required to register with a Provider Enrollment Chain and Ownership System. PECOS system allows providers to submit their enrollment information for Medicare and manage them. They then register for an NPI.
What NPI Data Is Available Publicly?
The following NPI data is available for the public to look up:
- Common identifiers
- Contact information
- Taxonomy
With a little more effort and the right tools, you can find ongoing fracking history, referral analysis, and more. There is a lot of hidden value in NPI information, which you can access with the NPI registry.
What Does the NPI Record Contain?
NPI records generally contain 329 points of data. Some of these are mentioned below.
Name
This is the legal name of a business that is associated with the healthcare provider. If it is an individual provider, the name here will be the first and last names.
NPI Number and Type
The 10-digit NPI number given to a provider, along with the type of NPI
- Type 1
These are individuals who are registered as healthcare providers. This includes physicians, dentists, and other sole proprietors.
- Type 2
This group consists of organizations that provide healthcare and related services.
Summary
An overview of the information is available here. It includes location, date of the information provided, and so on.
Contact Information
NPI Records contain phone and fa information where one can contact the provider.
Medical Licenses
It gives a list of medical documents that might be documented at a federal level.
Practice Location
You often find the physical location of a provider’s practice. These are some of the details provided by the NPI Database.
How Can NPI Be Used?
The NPI number can be used with the electronic transactions in HIPAA. However, people can use these numbers in several ways. Healthcare providers can use them to identify themselves, other healthcare providers, and any related correspondence. It can also be used by providers on prescriptions, although they do not replace license numbers. Health plans can use them for the processing of transactions and communication with other healthcare providers. They can also help to coordinate benefits with other health plans.
In addition, clearinghouses can use these numbers to facilitate internal files to create and move standard transactions. The NPI numbers help identify treating providers and cross-reference them in fraud and abuse files and important integrity files. It can even come in handy in other lawful activities that call for identification. These are optional uses that come from using and tracking NPIs using a dashboard or an NPI registry.
How to Use an NPI Search?
NPI searches can be complicated if you have not done them before. There are NPI Dashboards readily available. Using such boards, you can conduct NPI lookups using search fields like NPI, name, partial names, specialty, or even address information.
You can also use partial data like part of an organization’s name to look up a healthcare provider. This helps to look up NPI in any registry. You can also use a publicly available NPI registry to check details.
Things to Keep in Mind While Conducting NPI Lookups
You need to keep a few points in mind while carrying out NPI searches, especially from public records. NPI records change, and many public databases used by most websites constantly change almost every week. This means that unless there are automated updates set up, these changes might go unnoticed. Thus, it can give you wrong or outdated information.
Can You Monitor NPI Records?
You can track and monitor NPI information and referral data from the first records of 2005 to current records. It includes different users like the following.
- Patients who use the registry to find referral sources and validate a provider’s license before consulting
- Attorneys who use this data to conduct researches about fraud and referral pattern anomalies
- General public looking to find information about healthcare providers
You can use the NPI registry for any current lookup and validation related to NPI. This can also cover exclusions monitoring and other verification. People can even verify licenses and sanctions along with credential screening.
How to Understand NPI Results?
Understanding NPI results need not be highly complicated. The NPI number is a 10-digit number assigned to the provider. The enumeration date lets you know the date the NPI was assigned, while the NPI type helps identify if the provider is an individual or an organization. The status shows whether the NPI is deactivated or not, while the address gives you information about the mailing address, primary address, or practice location.
Taxonomy lets users know about the specialization and classification of the provider. For this field, providers can choose more than one option. It will also return the code and license number. Other identifiers are used to match the provider with insurers, while the endpoint information shows where any client can access the provider’s services. Since the NPI does not change once it is assigned, it is a great way to identify providers.
Conclusion
The NPI number is an essential tool to identify and monitor healthcare providers. Using the right dashboard can help you identify important information without much hassle. The availability of databases in multiple websites also makes it very accessible for those looking to find referrals and more.
