National Provider Identifier Information

HIPAA’s Administrative Simplification regulations specify standard record formats and code sets. The NPI Final Rule, published in January 23, 2004, Federal Register, takes those electronic record formats a step further and standardizes the way the healthcare industry recognizes providers. The Centers for Medicare & Medicaid Services (CMS) will assign a unique, permanent 10-digit number – the NPI – to every provider covered by HIPAA. The goal is to eliminate the need for providers to use a different identifier for each payer. CMS began accepting electronic and paper applications for NPIs on May 23, 2005. Providers must begin using the NPI in all applicable standard electronic transactions by May 23, 2007. Providers have been urged to apply well before the deadline to give their organization plenty of time to coordinate with third parties to design and test their systems for the change. Payers are recommended to start communicating with business and trading partners and determine the impact that the NPI has on your business operations. It is our goal at MedCost, to offer excellent customer service to our clients. The purpose of the following FAQs is to alert you about MedCost NPI implementation. FREQUENTLY ASKED QUESTIONS Q: Is MedCost ready to accept the NPI from network providers? A: Yes. MedCost is currently accepting the NPI from network providers through our National Provider Identifier (NPI) Submission Form located on www.medcost.com in the Physicians and Providers section. Q: Does MedCost plan to provide a list of NPIs to claim administrators? A: The NPI will be used in standard electronic transactions. We have updated our system to identify and input the NPI in our repricing functions. This implementation allows us to assure that the NPI is located on the standard electronic transaction. This is how we plan to disseminate the NPI to carriers. If you desire another method of dissemination from MedCost, please submit your request to sisley@medcost.com. Q: Is MedCost able to use and pass the NPI in standard electronic transactions? A: MedCost must comply with 837 standard electronic transactions and is currently working with our clearinghouses PayerPath and Emdeon to assure that MedCost has the capabilities to successfully pass the NPI. MedCost expects to be compliant by May 23, 2007. For additional information about the NPI, visit www.cms.hhs.gov/NationalProvIdentStand.