Beginning October 1, psychiatrists and other physicians participating in
Medicare will have the option to identify themselves on claims by using only
their National Provider Identifier (NPI).
Until that date, however, the Centers for Medicare and Medicaid Services
(CMS) asks physicians to use their current Uniform Provider Identification
Number (UPIN) and their new NPI on the claims they file.
The NPI system was federally mandated by the Health Insurance Portability
and Accountability Act of 1996 (HIPAA). The NPI, which replaces the UPIN,
functions much like a Social Security number—each is assigned for life
and never expires.
All HIPAA "covered entities" are required to obtain an
identifier. "Covered entities" are defined as providers, health
plans, hospitals, insurers, and health care clearinghouses that conduct
certain financial and administrative functions electronically, such as claims,
coordination of benefits transactions, and enrollment in health-plan
The NPI is the only identifier that most health plans, both public and
private, can use after May 23, 2007, to identify physicians. Smaller health
entities have until May 23, 2008, to comply.
NPIs are issued through the National Plan and Provider Enumeration System
(NPPES), which accepts applications filed online or through the mail.
As of mid-august, NPIs had been issued to about 850,000 of the nearly 2.5
million physicians and other providers that CMS believes needs them, according
to a CMS spokesperson.
As the transition to the NPI system progresses, however, concerns remain
over the security of the personal information that physicians must submit as
part of their NPI application. In a May 26 letter to CMS, the AMA said it
wanted to limit access to the CMS database of physician information and
prohibit the use of NPIs for any commercial purposes. CMS is now developing a"
data-dissemination policy" that will provide guidelines to
control access to the NPI database.
"Until CMS publishes the data-dissemination policy, however, little
is known about who will have access to the" to the NPI database, wrote
Michael Maves, M.D., executive vice president of AMA.
In a CMS-sponsored panel discussion on NPIs in July, a CMS representative
said that the data-dissemination policy had undergone many drafts, but no date
has been set for its release.
More information on the NPI and applications forms can be accessed