What is NPI Number Expiration? Is a New NPI Number a requirement?

Individual NPI number

The NPI, National Provider Identifier, is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Standard. An NPI is a one-of-a-kind identifier number for covered health care services designed to increase the quality and efficacy of electronic health information delivery. NPIs must be used in accounting and financial transactions by covered health care providers, all health insurers, and health care clearinghouses.

Get an NPI Number

The HIPAA Administrative Simplification requirements allowed each health care provider to use a normal, personalized health identifier. On January 23, 2004, the NPI Final Rule was issued, establishing the NPI as this standard. 

Do I need an NPI Number?

If you attempt to file a petition without an NPI number, it would almost certainly be rejected. This is true not only for Medicare claims but also for private payers. So, if you wish to be compensated for your work, you can obtain one of these 10-digit identification numbers. Furthermore, “NPIs can also be used to classify health care providers on prescriptions, in benefit-sharing between health insurers, patient medical record networks, in-service integrity files, and in other ways,” according to CMS. 

However, it is not yet another bureaucratic hurdle for healthcare professionals to jump through; it intends to save you time. NPIs help streamline the automated claims filing process by eliminating the need for providers to monitor and request insurer-specific identifiers.

How to Get an NPI Number?

NPIs can be obtained from physicians in one of three ways:

● Using a web-based implementation process to ensure the most efficient data processing and the fastest reception of NPIs. Simply go to the National Plan and Provider Enumeration System (NPPES) and download online (see the Related Links section below for the ‘Apply Now’ page).

● If an EFIO requests it, health care providers can agree to allow an Electronic File Interchange agency (EFIO) to submit application data on their behalf through a bulk enumeration mechanism.

● Health care professionals should get a paper NPI Submission/Update Form (CMS-10114) and mail it to the NPI Enumerator in Fargo, ND, where employees can type the application data into NPPES.

Individual NPI number

Do I need to Have an Individual NPI if my Facility has a Group NPI?

Many healthcare providers are unaware that there are two forms of NPIs. According to the CMS (Centers for Medicare and Medicaid Services), these are as follows.

Type 1: Specific healthcare providers, such as doctors, dentists, and sole proprietors, fall under this category. A person is only qualified for one NPI.

Type 2: Organizational healthcare providers, such as medical associations, hospitals, nursing homes, and the company created when a person introduces himself/herself into a collective practice.

If you are a solo practitioner or individual doctor, you must begin with a Type 1 NPI. Your personal NPI is similar to your social security number. It is a unique identification number for you as a healthcare provider.

A Type 2 NPI is for big and small community activities. A Type 2 NPI is needed for most group practices that provide superbills to their patients. Even if you are the only healthcare provider in your profession, having a Type 2 NPI may be needed in certain situations.

When you consider the two forms of NPIs in the sense of a patient undergoing care in a large hospital, their function becomes obvious. The health firm needs to know which hospital the patient went to, as defined by the NPI Type 2, and which of the hundreds of doctors who operate there really treated the patient, as defined by their specific Type 1 NPI.

Can I Change NPI Related Information?

In particular, if any provider data (for example, your practice’s address) changes, you must contact NPPES within 30 days. You may do it in one of three ways:

● Go to the online portal and follow the procedure to change the information.

● Print, fill, and submit the form, or 

● Call the NPI Enumerator at 1-800-465-3203 to ask for a form. 

Online NPI Portal

When Will I Need a New NPI Number?

Many often ask, do I need a new NPI number if I change jobs? Let’s see if this answers your question. 

An NPI, like a diamond, lasts forever – most of the time. According to CMS, a provider’s NPI is “meant to be a permanent identity, and is intended to remain unchanged even though a health care provider changes his or her name, address, provider taxonomy, or other details furnished as part of the initial NPI application process.” If some of the information has to be updated, follow the steps to update your information.

However, there are a very limited number of cases in which you would need to procure an entirely new NPI – for example if the existing one was used fraudulently. You will also need to acquire a new party NPI number as a result of “such shifts of ownership, the terms of a purchase, or the subpart tactics of a new owner.”

How Long Does it Take to Get an NPI Number?

A health care worker who submits a correctly completed online assessment should expect to receive their NPI within 10 days, but this can vary based on the number of applications received at any given time.

If you upload your application online with all of your information correctly filled out, you can get your NPI in less than 10 days. Usually, you will get it in 5 days or less. The paper submission procedure takes about 20 business days. Importantly, regardless of how you obtained your NPI, you must hold the notification log that NPPES sends to you. You will need to discuss this notification with other health care providers in the future.