National Provider Identifier
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA.
- The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.
- The provider’s NPI will not change and will remain with the provider regardless of job or location changes.
- The NPI must be used in lieu of Medicaid legacy IDs (UPIN, OSCAR, PIN, and National Supplier Clearinghouse or NSC). In North Carolina, the NPI replaces the Medicaid Provider Number (MPN).
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.
NPI and Taxonomy
Taxonomy codes must be included for the billing provider for all claims (except pharmacy).
NPI and Carolina ACCESS
If a Carolina ACCESS customer is referred to another provider, the NPI of the referring Carolina ACCESS provider must be included on all claims. If the customer is enrolled with an individual provider, obtain the individual provider’s NPI. If the individual is enrolled with the healthcare practice, use the practice’s NPI.
- Do not provide healthcare services and will not be issued NPI numbers
- Are individuals or businesses that bill Medicaid for services rendered but do not meet the definition of a healthcare provider according to the NPI Final Rule 45 CFR 160.103 (for example, non-emergency transportation providers)
- Will use provider identification numbers generated by NCTracks to file their claims