CMS to Host National NPI Roundtable on 2/6/2008
Posted: Jan. 29, 2008
The Workgroup for Electronic Data Interchange (WEDI) will host an audiocast to discuss NPI implementation from an industry-wide standpoint. The audiocast will be held on February 21, 2008. Visit here for registration details. Please note there is a charge to participate in WEDI events.

Information on Reporting a National Provider Identifier (NPI) for Ordering/Referring and Attending/Operating/Other/Service facility for Medicare Claims
Posted: Jan. 29, 2008
Visit here for a recently released MLN Matters Article on the topic of reporting NPIs for order/referring and attending/operating/other/service facility for Medicare claims.

Only 4 Months Until May 23rd - Test NPI-only claims NOW
Posted: Jan. 28, 2008
While Medicare is receiving well over 90% of claims containing an NPI in primary provider fields, there is a very small percent of claims submitted with NPI- only. Until you submit claims with an NPI-only, you will not have a preview of what your experience will be on May 23rd, should you need to correct any problems that may arise. CMS urges that ALL Medicare providers test NOW so that problems can be resolved prior to May 23rd. View instructions on how to test.

Remember, if you test and your claims are processed successfully, you can approach the May 23rd date with confidence. If you do not, you may face unanticipated cash flow problems.

Medicare's Key Dates
Posted: Jan. 28, 2008
There are two key dates remaining for 2008 in Medicare's NPI implementation plan. There is also some confusion as to the difference between the implementation steps for March 1st and May 23rd. This chart indicates the implementation steps for each date.

Industry-Wide Enforcement of the NPI Compliance Date
Posted: Jan. 28, 2008
By May 24, 2008, all covered entities are expected to be using the NPI in a compliant manner, and all contingency plans should be lifted. The compliance date for the NPI for all HIPAA covered entities except small health plans was May 23, 2007. (Small health plans have until May 23, 2008 to comply.) CMS announced that, through May 23, 2008, it would not impose penalties on covered entities that deploy contingency plans to facilitate the compliance of their trading partners. On May 24, 2008, CMS will lift its enforcement-leniency policy and CMS will impose penalties if the entity does not demonstrate compliance or corrective action.

This notice does not prohibit covered entities from lifting contingency plans prior to May 24, 2008.

NPPES and the NPI Enumerator: Misconceptions & Facts
Posted: Jan. 28, 2008
This file lists some common misconceptions and the facts that correct those misconceptions.

Search the NPI Registry
Posted: Nov. 14, 2007
The National Provider Identifier (NPI) Registry enables you to search for a provider's National Plan & Provider Enumeration System (NPPES) information. All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice. You may run simple queries to retrieve this read-only data. For example, users may search for a provider by the NPI or Legal Business Name. There is no charge to use the NPI Registry.

Medicare Announces the NPI Implementation Date
Posted: Nov. 07, 2007
This is an important message for providers that bill Medicare carriers, A/B Medicare Administrative Contractors (MACs), and DME MACs using an Electronic Claim Form (ASC X12 837P) or Paper Claim Form (CMS-1500). The Centers for Medicare & Medicaid Services (CMS) announced that since the vast majority of Medicare claims are being sent to Medicare with a National Provider Identifier (NPI) and the Medicare NPI crosswalk is successfully crosswalking NPIs to legacy numbers for most claims, CMS will be moving towards full implementation of the NPI in Medicare. Effective March 1, 2008, your Medicare fee-for-service claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. Claims containing only a legacy identifier in the primary fields and/or failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008. Until further notice, you may continue to include legacy identifiers only for the secondary fields.

The NPI Registry and NPI Training Package Now Available
Posted: Sep. 18, 2007
View the Registry.
Download the file.

Module 4, Data Dissemination in the NPI Training Package also available
Posted: Sep. 18, 2007
This module describes the policy by which CMS will make certain NPPES data available, as well as the data CMS is disclosing.

Transcript for the August 2nd NPI Roundtable Now Available
Posted: Aug. 29, 2007
The transcript for the August 2nd, Medicare FFS Q&A Session: Common Billing Errors, Roundtable is now available on the CMS NPI page.
Contact: Iara Woody

Medicare Efforts to Minimize Claim Rejections and Suspensions
Posted: Aug. 29, 2007
CMS CR5649, Transmittal number 1262 dated June 8, 2007, instructed Medicare Contractors to identify providers who are not submitting their National Provider Identifier (NPI) and who have the highest volume of rejections (or potential rejections/informational edits) due to invalid NPI information. Contractors have begun calling providers that fit these categories asking them to validate their National Plan and Provider Enumeration System (NPPES) information or confirm that the information in the Contractor’s Provider file is correct. If you are not submitting your NPI at this time, your Contractor will need to know why you are not submitting it, the date you plan to submit it, and will ask for you to send a small batch of claims using your NPI only, if possible. If your NPI is tied to several legacy identifiers, your contractor may contact you in the event that a claim suspends due to problems mapping your NPI to a legacy number. If the claim is suspended due to incorrect data in the Contractors provider file or NPPES, the provider will be requested to either update their information in NPPES and/or submit an updated CMS–855 form. Providers in this situation must respond within 14 days to avoid unprocessed claims.

More information and education on the NPI can be found through the CMS NPI webpage.

Contact: Iara Woody

Medicare’s Implementation of the NPI: The Second in the CMS Series of MLN Matters Articles
This article was revised on August 7, 2007, to delete a reference to the NPI viewlet, which is no longer available on the CMS website. Among other topics, this article states taht for some period after May 23, 2007, Medicare FFS will allow continued use of legacy numbers on transactions; accept transactions with only NPIs; and accept transactions with both legacy numbers and NPIs.

NPI Registry Data Dissemination to Begin September 4, 2007
The National Plan and Provider Enumeration System (NPPES) health care provider data will be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS) via the Internet. Data will be available in a query-only database (the “NPI Registry”), and a downloadable file. In order to ensure edits are reflected in the NPI Registry when it first becomes operational and in the first downloadable file, health care providers need to submit their edits no later than Monday, August 20, 2007. Health care providers who submit edits on paper need to ensure that they are mailed in time for receipt by the NPI Enumerator by that date. The NPI Registry will become operational on September 4 and the downloadable file will be ready approximately one week later.
Providers who need assistance in making their edits, click here.

The NPI Compliance Deadline is Here!
At this point, any covered entity that is noncompliant, and has not implemented a contingency plan, is at risk for enforcement action. Please review the April 2, 2007 CMS "Guidance on Compliance with the HIPAA National Provider Identifier (NPI) Rule." As this guidance pertains to claims transactions, it means that:

1. Providers must have and use their NPI;
2. Clearinghouses must accept and use NPIs; and
3. Health plans must accept and send NPIs in claims transactions.

Providers should be:

1. Aware of contingency plans for any health plans they bill. Contingency plans may differ by health plan.
2. Aware that health plans may lift their contingency plans (and require an NPI on claims or other HIPAA transactions) any time before May 23, 2008.
3. Working with vendors and clearinghouses with whom they contract, to make sure the NPI is being passed to health plans.
4. Paying close attention to how and when health plans will be testing implementation of the NPI.
5. Aware that, for those health plans that did not establish a contingency plan, providers are required to use their NPIs now. This means that if you are not using your NPI, your claim may be rejected or denied.

New Compliance Contingency Guidance
Posted: April 27, 2007
Covered entities (including health plans, covered health care providers and clearinghouses) across the country should be preparing contingency plans for NPI implementation. It is more important to obtain an NPI as soon as possible and begin testing it on claims, as directed by your health plan. FAQs on NPI Compliance Contingency Guidance are available on the
CMS dedicated NPI web page. In addition to the FAQs, CMS strongly urges providers to pay attention to information from the health plans they bill so that they are aware if, and when, a specific health plan announces its own contingency plan.

When to Contact the NPI Enumerator for Assistance
Posted: April 27, 2007
Providers should remember that the NPI Enumerator can only answer/address the following types of questions/issues:

• Status of an application
• Forgotten/lost NPI
• Lost NPI notification letter (i.e., for those providers enumerated via paper or web-based applications)
• Trouble accessing NPPES
• Forgotten password/User ID
• Need to request a paper application
• Need clarification on information that is to be supplied in the NPI application

Providers needing this type of assistance may contact the enumerator at 1-800-465-3203, TTY 1-800-692-2326, or email the request to the NPI Enumerator.

Important Information for Medicare Providers: Medicare Fee-For-Service (FFS) Contingency Plan Announced!
Posted: April 27, 2007
FFS Medicare has announced its contingency plan. Veiw the related MLN Matters articleon the CMS website.

A national NPI Roundtable on the Medicare FFS Contingency Plan is scheduled for May 10, 2007 from 2-3:30PM EDT. Registration details to follow.

Medicare Extending Date for Accepting Form CMS-1500 (12-90)
Posted: April 27, 2007
Medicare began to accept the new and revised Form CMS-1500 (08-05) on January 1, 2007 and the compliance date was supposed to take place on April 1, 2007. Due to incorrectly formatted versions of the revised form being sold by the Government Printing Office (GPO), which do not comply with the form specifications, CMS has extending the acceptance period of the Form CMS-1500 (12-90) version beyond the original April 1, 2007 deadline. Medicare contractors will be directed to continue to accept the Form CMS-1500 (12-90) until June 1, 2007. In the mean time, contractors will be directed to return, not manually key, any Form CMS-1500 (08-05) forms received which are not printed to specification. By returning the incorrectly formatted claim forms back to providers, CMS is able to make them aware of the situation so they can begin communications with their form suppliers.

For more details, and to learn how to identify the proper version of the new form, visit a recent MLN Matters article on the CMS website.

FFS Medicare has announced its contingency plan.
Posted: April 26, 2007
Medicare Fee-For-Service (FFS) NPI Implementation Contingency Plan Announced.
View the associated Change Request
See the related MLN Matters article
(This information will also be available shortly on the dedicated NPI page. A national NPI Roundtable on this topic is scheduled for May 10, 2007 from 2-3:30PM EDT. Registration details to follow.)

Guidance on Compliance with the NPI
Posted: April 24, 2007
The Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a contingency plan for covered entities (other than small health plans) who will not meet the May 23, 2007, deadline for compliance with the National Provider Identifier (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Important Information for Medicare Providers
Posted: Mar. 01, 2007
In addition to updating critical data and legacy identifiers in the NPPES, Medicare providers should include both their NPIs and their Medicare legacy numbers in their Medicare claims. This will help Medicare build its NPI crosswalk by enabling Medicare to link providers’ NPIs to their Medicare legacy identifiers. Also, when Medicare providers make changes to their Medicare enrollment information, they are now required to furnish their NPIs when making those changes. Providers applying for Medicare enrollment must furnish their NPIs on their enrollment applications. These actions inform Medicare of providers’ NPIs. There are no additional actions that Medicare providers need to take to inform Medicare of their NPIs.

What is an NPI? How you get it, share it and use it.
Mar. 01, 2007
Still Confused? As always, more information and education on the NPI can be found at the CMS NPI page on the CMS website. Providers can apply for an NPI online at or can call the NPI enumerator to request a paper application at 1-800-465-3203.

Sharing NPIs
Mar. 01, 2007
Once providers have received their NPIs, they should share their NPIs with other providers with whom they do business, and with health plans that request their NPIs. In fact, as outlined in current regulation, providers must share their NPI with any entity that may need it for billing purposes -- including those who need it for designation of ordering or referring physician. Providers should also consider letting health plans, or institutions for whom they work, share their NPIs for them.

Upcoming WEDI Events
Mar. 01, 2007
WEDI has several NPI events scheduled in the upcoming month. Please note that there is a charge to participate in WEDI events.

New Frequently Asked Questions (FAQs) Posted
Mar. 01, 2007
CMS has posted new NPI FAQs on its website. Questions include:

• For Medicare provider enrollment purposes, will group practices need to submit new CMS-855R’s for every member of the group practice in order to let Medicare know their NPIs?
• Will health plans link the National Provider Identifiers (NPIs) of group practices to the NPIs of the health care providers who are members of the group practices?
• Who needs an NPI – who is not eligible to apply for an NPI - what if I have a Drug Enforcement Administration (DEA) number – what if I only bill on paper – what if I do not submit claims to Medicare?
• Can my office Employer Identification Number (EIN) be used instead of a National Provider Identifier (NPI)?
• When do I need to use my National Provider Identifier (NPI)?
• Is a corporation that owns pharmacies that have National Provider Identifiers (NPIs) required to have an NPI in order to receive payments on behalf of the owned pharmacies?

To view these FAQs, please go to the CMS dedicated NPI webpage at and click on Educational Resources. Scroll down to the section that says “Related Links Inside CMS” and click on Frequently Asked Questions. To find the latest FAQs, click on the arrows next to “Date Updated”.

Are You Ready for the NPI? 90 Days Left.
Feb. 28, 2007
There are less than 90 days left between today and the NPI compliance date of May 23, 2007. It is estimated that it may take at least this much time to implement the NPI into your business practices. Failure to prepare could result in a disruption in cash flow. All health care providers, including Medicare providers, should include their legacy identifiers, as well as associated provider identifier type(s), on their NPI applications. If a provider has already completed an application and did not submit a legacy identifier, this provider should go back and update its information in NPPES. While doing so, providers should also validate other data in NPPES, such as address, contact person information, etc. and update anything that has changed.

Get Your National Provider Identifier (NPI) ASAP
Posted: Jan. 02, 2007
May 23 is the deadline for healthcare providers who bill Medicare to begin using their National Provider Identifiers on their payment claims. If you have not already done so, you must begin the application process immediately.

9/26 NPI Roundtable Transcript Available Now
posted: October 17, 2006
The transcript for the 9/26 NPI Roundtable is now availabe at the CMS website.

October 25th WEDI Audiocast
Registration is open for the WEDI audiocast “NPI 101 – And We’re Off! Getting Up To Speed On NPI” to be held on October 25th from 2-3:30PM ET. Learn more about this audiocast, and how to register, on the WEDI website. Please note - there is a cost to participate in this audiocast.

NPI Training Package: Module 5 Available Now
posted: October 13, 2006
Module 5, Medicare Implementation, provides the NPI requirements specific to Medicare providers. This module will be updated as new requirements are announced or changes are made. Module 5 is now posted on the CMS NPI Page.

Reminder to Supply Legacy Identifiers on NPI Application
posted: September 28, 2006
CMS continues to urge providers to include legacy identifiers on their NPI applications. This will help all health plans, including Medicare, to get ready for May 23, 2007. If reporting a Medicaid legacy number, include the associated State name. If providers have already been assigned NPIs, CMS asks them to consider going back into the NPPES and updating their information with their legacy identifiers if they did not include those identifiers when they applied for NPIs. This information is critical for health plans and health care clearinghouses in the development of crosswalks to aid in the transition to the NPI.

Information on Covered Entities Under HIPAA
posted: September 26, 2006
CMS has posted a new “Frequently Asked Question” to the CMS website that addresses whether a health care provider is a covered entity under HIPAA if they receive health information electronically (e.g. an electronic remittance advice), but do not transmit any health information electronically. The link is listed below or you can go to the CMS.gov website and click on “Questions” in the blue banner.

Covered Entity Chart
posted: September 07, 2006
This chart serves as a guidance on how to determine whether an entity is a covered entity under the Administrative Simplification provisions of HIPAA.

NEW!! NPI Training Package
posted: September 5, 2006
CMS has developed a Training package on NPI that will assist providers with self-education, as well as education of staff. This package is also useful to national and local medical societies for group presentations and training. The entire package will consist of five modules: General Information, Electronic File Interchange (EFI), Subparts, Data Dissemination and Medicare Implementation. Each Module consists of a PowerPoint presentation (with speaker's notes) and is designed to stand alone or can be combined with other Modules for a training session tailored to the particular audience. Modules will be posted to the CMS NPI web page as completed.

Modules currently available include:

Module 1: General Information
Module 2: Electronic File Interchange (EFI)
Module 3: Subparts

To view these Modules, visit the CMS NPI web page and find the "NPI Training Package" under the "Downloads.”

Atypical Service Providers – Who Should Apply for the NPI
posted: August 30, 2006
The National Provider Identifier (NPI) Final Rule stipulates that only entities who meet the definition of "health care providers" found at 45 CFR 160.103 are eligible for NPIs. There are a number of entities who do not meet this definition who are therefore not eligible for NPIs, but whose services are payable by some health plans. The NPI Final Rule refers to these entities as “atypical service providers” because the services they render are not “health care” services. This document provides examples of many types of atypical service providers, such as certain assisted living facilities, and whether these facilities should apply for an NPI.

National NPI Roundtable, September 26
posted: August 23, 2006
August 23rd marks 9 months remaining until the National Provider Identifier (NPI) compliance date. Over 1 million NPIs have been issued so far --- do you have your NPI yet? CMS will host a national NPI Roundtable, open to all health care professionals, on Tuesday, September 26th from 2:00-3:30PM ET. To participate, you may call 1-877-203-0044, pass code 4795739. CMS will address common questions related to Medicare’s guidance on Subparts. While CMS will only address questions from a Medicare perspective, this information may be helpful to all providers. Medicare providers who have questions, should
select the appropriate email and send in questions by Friday, September 8th. Questions received after this date will not be considered.

Important Guidance On National Provider Identifier (NPI) Usage in Medicare Claims
posted: August 23, 2006
This MLN Article states that carriers have reported errors on claims that will impact payment when providers begin to submit NPIs. To prevent your transactions from being rejected by the carrier, make sure that your billing staffs are using your NPI correctly when they submit your claims for services provided to Medicare beneficiaries or submit electronic beneficiary or claim status queries to Medicare. Contact: Iara Woody ; 202-508-9429;

Medicare NPI Implementation
posted: August 14, 2006
This link provides Medicare's implementation involving acceptance and processing of transactions with the NPI.

Upcoming NPI Outreach Events
posted: July 5, 2006
CMS and the Workgroup for Electronic Data Interchange (WEDI) are working together to ensure that all healthcare providers are educated and informed on the new National Provider Identifier (NPI). As such, there are a few upcoming outreach events, sponsored by WEDI, that healthcare providers may find helpful:

Taxi-ing to the Taxonomy Code Audiocast
July 26th from 2 - 3:30PM Eastern Time

WEDI NPI Industry Forum IV: NPI Is Knocking At Your Door—Will You Let It In?
August 15th and 16th at the Hyatt Fair Lakes in Fairfax, VA

Please note that there is a cost to participate in these events. To learn more about the events, as well as the latest news on WEDI NPI outreach, visit the Workgroup for Electronic Data Interchange website.

The Who, What, When, Why & How of NPI
posted: May 19, 2006
Starting May 23, 2007, the NPI will replace all of your existing provider numbers that you use to bill Medicare, Medicaid, and other health care payers. If you have not yet obtained your NPI number, CMS encourages you to do so soon even if you are not enrolling or making a change to your Medicare enrollment information. Click HERE to find and information sheet designed to provide basic information about the NPI, including the three different ways to apply for your NPI.

New Medicare Provider Enrollment Process
posted: May 19, 2006
On May 1, 2006, the Centers for Medicare & Medicaid Services (CMS) introduced the revised CMS 855 Medicare provider enrollment applications. As part of the revised enrollment process, initial enrollees and existing enrollees making changes to their enrollment information must include their National Provider Identifier (NPI) number and a copy of the National Plan and Provider Enumeration System (NPPES) NPI notification with the enrollment application. No initial application can be approved and no updates to existing enrollment information can be made without this NPI information. All health care providers and suppliers who bill Medicare are required to obtain their NPI in advance of enrolling in or changing their Medicare enrollment data.

Getting Ready for the NPI
posted: April 28, 2006
EVERY provider completing electronic transactions MUST use only the NPI to identify covered healthcare providers in standard transactions by May 23, 2007. Click HERE for tips on how to get started.

New Educational Products
posted: March 8, 2006
CMS has released three new educational products on the National Provider Identifer (NPI):

Suitable for All Health Care Providers

• A Subparts Fact Sheet that contains high-level information on Medicare's guidance on subpart designation. Although the guidance is geared toward Medicare organization providers, non-Medicare organization providers may find it helpful.
• An Electronic File Interchange (EFI) Fact Sheet that contains basic information and links to helpful resources that will prepare providers and their staff for the release of the EFI system. This information is essential for organizations that wish to submit electronic files for bulk enumeration, and may be of interest to any health care provider for whom an organization will be submitting NPI application data.

Suitable for Medicare Providers

• A MLN Matters Article (SE0608) that takes a detailed look at Medicare's guidance on subpart designation and the impact on Medicare providers.

NPI Tip
posted: March 8, 2006
When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI.

National Provider Identifier (NPI)
posted: February 13, 2006
This page contains comprehensive information on the Medicare National Provider Identifier implementation. A new fact sheet with answers to questions that health care providers may have regarding the NPI is now available on this web page. This section will continue to be updated with new information and resources.

Frequently Asked Questions
posted: February 11, 2006
Provides frequently asked questions on the NPI and is frequently updated with new questions and answers.

Information on Electronic File Interchange (EFI)
posted: February 11, 2006
EFI, also referred to as "bulk enumeration," is a process by which a health care provider or group of providers can have a particular organization (the "EFIO") apply for National Provider Identifiers (NPI) on their behalf.

Final Rule
posted: February 8, 2006
The final rule adopting the Health Insurance Portability & Accountability Act of 1996 (HIPAA) standard unique health identifier for health care providers was published in the Federal Register on January 23, 2004. To view the final rule, click here. You can also download an overview of the final rule.

How to Apply for an NPI
posted: February 8, 2006
This link provides detailed instructions on how providers may apply for an NPI. Individual providers should apply now for an NPI. Health care providers who participate in a group practice, or are organizational providers, should coordinate with their organization to determine the appropriate time for NPI application.

NPI Fact Sheet
posted: February 8, 2006
This general fact sheet provides answers to important questions health care providers may have about the NPI. For health care providers who are individuals, click here for specific information.

CMS NPI Viewlet
posted: February 8, 2006
The NPI Viewlet, an instructional tool, provides an overview of the NPI, a walkthrough of the NPI application, as well as live links to the NPPES website where the learner can apply for an NPI. This tool is designed for all health care providers.