The National Provider Identifier is a unique identification number for health care providers used by all health plans. Health care providers and all health plans and health care clearinghouses use the NPI in administrative and financial transactions. Health plans assign identification numbers to health care providers: individuals, groups or organizations that provide medical or other health services or supplies. The NPI was instituted in 2007 to reduce problems associated with multiple identification numbers and formats used by multiple companies.
NPI frequently asked questions
Q: Who needs an NPI?
A: Any entity that files claims electronically, checks benefits eligibility online, or receives payments electronically needs an NPI. A dermatology practice submitting claims electronically to payers (even if they are submitted through a billing service) must have an NPI. Dermatologists in different practice arrangements will have differing needs as outlined below:
- A solo dermatologist: If you are a solo dermatologist, your individual NPI also is the practice's NPI. You will only apply for and receive one NPI.
- Groups: If a dermatologist and his or her colleagues do not file claims under a group number, they will have to file under their own NPI. Even if a dermatology practice does file under a group number, the individual physicians who render billed services must be identified on electronic claims submitted to both Medicare and private payers, so they should obtain individual NPIs as well. If you participate in Medicare, you must use the NPI as your ID number on all claim forms, including paper; all health plans will eventually require the NPI.
- Consulting physicians: Any dermatologist who refers patients to a hospital or accepts consultation requests from other physicians will likely need an NPI, as the physicians with whom they coordinate care will need to include the dermatologist's NPI on claim forms to be paid.
- Non-physician providers: Besides physicians, other health care providers, including nurse practitioners and physician assistants, who now file claims or have their services billed under a legacy number need NPIs.
Q: How should I select a taxonomy (specialty type) code when I apply? Can I select more than one?
A: NPI applicants are required to select one or more taxonomies, or specialty types, when they apply. CMS suggests that dermatologists select the taxonomy code for the general specialty (Dermatology - 207N00000X) as well as any other taxonomy sub-codes that may apply to their scope of dermatologic clinical service. The taxonomy codes in dermatology include:
- Dermatology - 207N00000X
- Clinical and Laboratory Dermatological Immunology - 207NI0002X
- Dermatological surgery - 207NS0135X
- Dermatopathology - 207ND0900X
- Mohs-micrographic surgery - 207ND0101X
- Pediatric dermatology - 207NP0225X
More information about each taxonomy code is available online at the taxonomy codes website.
Q: What should I do once I have an NPI?
A: After obtaining an NPI, dermatologists should contact their practice management and billing software vendors to learn the details of any required software upgrade in order to transmit claims and other electronic transactions with the NPI. Some vendors may provide these updates as part of a service contract; practices that no longer pay for software support may have to pay for an upgrade to include the NPI on their claims.
Q: What if I don't know a doctor's NPI, may I ask him or her for it?
A: CMS is advising that anyone who needs to know a provider's NPI for purposes of using it in a HIPAA standard transaction (i.e., claims submission, coordination of benefits, patient eligibility/verification, claim status, claim payment and remittance advice, referrals, certification, and authorization requests and responses) can ask the provider. If the provider is a covered HIPAA entity he or she must disclose their NPI, if requested, so it can be used to identify that provider. CMS is expected to issue a Data Dissemination Notice policy that will address requesting and disclosing NPI's for purposes of HIPAA standard health care transactions.
Q: Am I allowed to give my NPI to other providers as well as to the health plans with whom I exchange transactions?
A: Yes. CMS encourages all health care providers to communicate their NPI to health plans and clearinghouses with whom they exchange transactions and conduct business, as well as with other providers to whom they make referrals, or from whom they receive referrals.