National Provider Identifier (NPI)

The Health Insurance Portability and Accountability Act (HIPAA) mandates a standard 10 position unique identifier for health care providers effective May 23, 2007.  This unique identifier is the National Provider Identifier (NPI), which will replace health care provider identifiers used in HIPAA standard transactions today.  All health care providers who are HIPAA covered entities must obtain NPIs to identify themselves in HIPAA standard transactions by May 23, 2007.  Small health plans are allowed an additional 12 months to comply.  Please note, participating providers are HIPAA covered entities. 

For more information on obtaining your NPI, you may visit the CMS website at http://www.cms.hhs.gov/NationalProvIdentStand/03_apply.asp.

Help Ensure a Smooth Transition – Contact CMS Now to Obtain Your NPI

Providers are encouraged to obtain their new NPIs now from the Centers for Medicare and Medicaid Services (CMS).  If you have not already done so, visit the CMS website at www.cms.hhs.gov/NationalProvIdentStand/ . 

Register Your NPI with CMSP

CMSP is working to comply with the federal mandate and to ensure uninterrupted operations with the provider community. Providers are encouraged to register their NPIs as soon as possible.  Registration ensures our internal systems accurately reflect your NPI information. Failure to submit your NPI on claims submissions after May 23, 2007 may result in claim(s) being rejected and returned to provider for NPI.  After receiving your NPI, please complete our online submission form, at https://npi.wellpoint.com, to register your NPI.    

**NEW **NPI Batch Enumeration Registration:
In order to assist provider groups and large facility providers, CMSP has created a new process for providers to submit multiple NPIs at one time.  This process, known as the NPI Batch Submission Process, allows provider groups to submit multiple NPI entries along with additional identifying information using an MS Excel file template.   The MS Excel file template is available for downloading on the NPI Online Submission Web Site at https://npi.wellpoint.com.   Also on this site, you will find instructions on how to complete the MS Excel file template.  The completed MS Excel File can be sent to our NPI Bulk Submission address at npi.bulk.submission@wellpoint.com, or it can be faxed to your respective Provider Network Representative at 978-474-6188.  

Assess System Capabilities Early

Preparation for NPI may also require providers to assess and upgrade their existing systems or have discussions with their electronic vendors to ensure compliance with NPI requirements.  Contact your vendor today. 

In addition, testing is a key component of the NPI preparation process.  A physician office or facility may be able to minimize problems by testing early with electronic vendors and Children’s Medical Security Plan.  By preparing in advance, providers can help ensure a seamless conversion to NPI, minimizing any potential payment disruptions in their operations with CMSP.

HIPAA Frequently Asked Questions