The national provider identifier (NPI) number is a unique 10-digit number that identifies a health care provider in HIPAA standard transactions. It must be used in place of all legacy provider identifiers such as UPIN, OSCAR, etc.
Health care providers must use NPIs on electronic transactions adopted by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Additionally, health care providers need an NPI so they can be identified on electronic transactions performed by other entities.
If you are not using your NPI in electronic transactions, contact your EDI vendor to find out the steps you need to take to begin.
Get an NPI number
Enter your NPI application.
NPI number vs. tax ID number
- Both the tax ID number and NPI number of the billing provider are always required on claims.
- Identify other providers (rendering provider, service facility, etc.) with their NPI only.
Use of the NPI in electronic claims
The requirement for use of the NPI has not caused any change to claims adjudication.
- We use the billing provider tax ID number, NPI, billing provider name, and address.
- The NPI can also be used to identify the appropriate provider.
- The rendering provider's NPI must be entered in box 24-J on the CMS-1500 form.
- Priority Health will reject claims if the NPI is missing.
- We can accept the NPI from your claim, but we will return the NPI that is listed in our system if it is different.
- You may ask us to return your subpart NPI back instead of the one that is listed in our system. Email your request to PH-PELC@priorityhealth.com.
- See additional billing requirements.
Use of the NPI on paper claims
NPIs are only required on electronic transactions. However, paper claim forms now include NPIs and we recommend you include them.
- Additional information on the CMS-1500 form is available at www.nucc.org. Select "1500 claim Form," then "1500 Instructions."
- You may also subscribe to the UB-04 manual; visit www.nubc.org.
For more information on the NPI, review information on the CMS website.
- NPI numbers
- Electronic funds transfer (EFT)
- Physician status
- Open or close to new patients
- Availability standards
- Changes to address or staff
- Provider-patient relationship
- Medical & office records
- Medicaid patient treatment
- Medicare patient treatment
- Site visits
- Fraud, waste & abuse
- Utilization Management Program