National Provider Identifier (NPI)
The standard, unique health care NPI is part of the HIPAA Administration Simplification Regulations. The final rule, published January 23, 2004, established a standard unique identifier for all health providers under HIPAA. The rule implements federally mandated administrative simplification initiatives that have a national health care scope beyond Medicare and Medicaid.
HIPAA defined a covered entity as a Health Care Provider, Clearinghouse or Health Plan that conducts standard electronic transactions. The transactions include claims, eligibility inquiry and responses, claims status inquiries and responses, referrals, and remittance advices. The final rule for the NPI requires a “covered entity” Health Care Provider to obtain a National Provider ID (NPI).
In order to comply with these regulations, the Health Plan is collecting NPIs from any provider who wishes to submit claims on or after May 23, 2008. After May 23, 2008, the Health Plan will no longer accept legacy numbers from providers for electronically submitted claims. Therefore, it is crucial for providers to obtain and share their NPI numbers with the Health Plan to prevent potential payment disruptions.
NPI Frequently Asked Questions
How to apply for an NPI
As the industry transitions to NPI compliance, remember that there is no charge to get an NPI.
Providers can apply online for their NPI, or call (800) 465-3203 to request a paper application. Either method is free of charge.
The CMS NPI Overview page is the only source for official and authoritative education on the NPI initiative; all products located on this site are free of charge.
How to submit your NPI to the Health Plan
Submit your NPI online via the NPI Online Submission Form
Click here to submit your Type 1 NPI
Click here to submit your Type 2 NPI
Fax the NPI Submission Form to your Provider Relations Representative:
Danville: (800) 876-5357
Harrisburg: (888) 281-5338
Sayre: (800) 734-3141
Scranton: (800) 350-6486
State College: (888) 669-4834
You may submit the following information via e-mail to npi@thehealthplan.com:
Required information for Organizations: Entity name, physical address, tax identification number, taxonomy and ten digit NPI number.
Required information for Individuals: Provider name, physical address, tax identification number, taxonomy and ten digit NPI number.
Complete the NPI Submission Form or print your NPPES confirmation e-mail and mail to:
Provider Relations Representatives
100 North Academy Ave.
Danville, PA 17822-3020