	NPI Compliance The HIPAA National Provider Identifier (“NPI”) regulation is just one more regulation that falls under the umbrella of the overall HIPAA electronic data interchange (“EDI”) regulations, has a compliance deadline of May 23, 2007 for large health plans. The compliance deadline for small health plans is May 23, 2008. As defined under HIPAA, a small health plan is a health plan with annual receipts of $5 million or less. A large health plan is a health plan with annual receipts of greater than $5 million. What is the Objective of the HIPAA NPI Regulation? The use of a national provider identification system in connection with health care transactions will result in the use of a unique identifier referred to as the NPI which will be assigned to each HIPAA-affected health care provider. As of the compliance date, health plans, or payers on behalf of the health plan, must accept the NPI and use it in processing of claims transactions and providers must use it in submitting claims. The use of the NPI will improve the efficiency of the health care industry by simplifying the administration and facilitating the efficient transmission of health care information. What is the NPI? The NPI is a 10-digit number with no specific provider-unique intelligence contained in the identifier and a check digit in the 10th position. According to the HIPAA NPI regulation, this standard will allow for the issuance of at least 200 million NPIs. If additional NPIs are needed at a later date, additional digits will be added to the identifier at that time. The HIPAA NPI regulation requires that HIPAA-covered health care providers obtain a provider number from the Centers of Medicare & Medicaid Services (through the National Plan and Provider Enumerator System) and begin using the number in standard health care transactions (i.e. both electronic and paper transactions) by May 23, 2007. Who is Affected? A “covered entity” is required to comply with the HIPAA NPI regulation. Covered entities include health care providers, health plans and health care clearinghouses. You may apply for the NPI online. The NPI is free. More information about the NPI can be found on the CMS website. Facts you should know: By May 23,2007, CenBen USA systems will be ready to accept and use the NPI to identify providers in transactions involving claims, eligibility, referrals and remittance statements. CenBen USA will be able to accept the new forms – CMS 1500, UB04 and 2006 ADA- to process claims. CenBen USA has made the necessary changes to accept an electronic feed of provider information that includes the NPI from its business partners. There are two levels of NPI. Entity Type 1 is for individual health care partners, including physicians and all sole proprietors. Entity Type 2 is for healthcare organizations, including hospitals, physician groups or subparts of an organization. Your Tax Identification Number is still a required number in a healthcare transaction. Please assist us with collection of your NPI information. You can be assured that the information will be held in strict confidence. You may mail a copy of your enumeration form to our address: CenBen USA 2630 Elm Hill Pike, Ste 203 Nashville, TN 37214 You may fax the information to (615) 695-8581. Or you can complete the information on the next page. We have included a place for your demographic information so we can be sure our system is current.

NPI Compliance

The HIPAA National Provider Identifier (“NPI”) regulation is just one more regulation that falls under the umbrella of the overall HIPAA electronic data interchange (“EDI”) regulations, has a compliance deadline of May 23, 2007 for large health plans. The compliance deadline for small health plans is May 23, 2008. As defined under HIPAA, a small health plan is a health plan with annual receipts of $5 million or less. A large health plan is a health plan with annual receipts of greater than $5 million.

What is the Objective of the HIPAA NPI Regulation?

The use of a national provider identification system in connection with health care transactions will result in the use of a unique identifier referred to as the NPI which will be assigned to each HIPAA-affected health care provider. As of the compliance date, health plans, or payers on behalf of the health plan, must accept the NPI and use it in processing of claims transactions and providers must use it in submitting claims.

The use of the NPI will improve the efficiency of the health care industry by simplifying the administration and facilitating the efficient transmission of health care information.

What is the NPI?

The NPI is a 10-digit number with no specific provider-unique intelligence contained in the identifier and a check digit in the 10th position. According to the HIPAA NPI regulation, this standard will allow for the issuance of at least 200 million NPIs. If additional NPIs are needed at a later date, additional digits will be added to the identifier at that time.

The HIPAA NPI regulation requires that HIPAA-covered health care providers obtain a provider number from the Centers of Medicare & Medicaid Services (through the National Plan and Provider Enumerator System) and begin using the number in standard health care transactions (i.e. both electronic and paper transactions) by May 23, 2007.

Who is Affected?

A “covered entity” is required to comply with the HIPAA NPI regulation. Covered entities include health care providers, health plans and health care clearinghouses.

You may apply for the NPI online. The NPI is free. More information about the NPI can be found on the CMS website.

Facts you should know:

By May 23,2007, CenBen USA systems will be ready to accept and use the NPI to identify providers in transactions involving claims, eligibility, referrals and remittance statements.
CenBen USA will be able to accept the new forms – CMS 1500, UB04 and 2006 ADA- to process claims.
CenBen USA has made the necessary changes to accept an electronic feed of provider information that includes the NPI from its business partners.
There are two levels of NPI.
Entity Type 1 is for individual health care partners, including physicians and all sole proprietors.
Entity Type 2 is for healthcare organizations, including hospitals, physician groups or subparts of an organization.
Your Tax Identification Number is still a required number in a healthcare transaction.

Please assist us with collection of your NPI information. You can be assured that the information will be held in strict confidence. You may mail a copy of your enumeration form to our address:

CenBen USA
2630 Elm Hill Pike, Ste 203
Nashville, TN 37214
You may fax the information to (615) 695-8581.
Or you can complete the information on the next page. We have included a place for your demographic information so we can be sure our system is current.