On May 1, 2006, the Centers for Medicare & Medicaid Services (CMS) introduced the revised CMS 855 Medicare provider enrollment applications.  As part of the revised enrollment process, initial enrollees and existing enrollees making changes to their enrollment information must include their National Provider Identifier (NPI) number and a copy of the National Plan and Provider Enumeration System (NPPES) NPI notification with the enrollment application.  No initial application can be approved and no updates to existing enrollment information can be made without this NPI information.  All health care providers and suppliers who bill Medicare are required to obtain their NPI in advance of enrolling in or changing their Medicare enrollment data.

If you are an individual or sole proprietor, who furnishes health care, you are eligible for one and only one NPI.  If you are an individual who is a health care provider and who is incorporated, you may need to obtain an NPI for yourself and an NPI for your corporation or LLC.  If you are an organization that furnishes health care, you may determine that you have components, called “subparts,” that need their own NPI.  For additional information about the NPI, please go to http://www.cms.hhs.gov/NationalProvIdentStand/.

If you have not yet obtained your NPI number, CMS encourages you to do so soon even if you are not enrolling or making a change to your Medicare enrollment information.  An information sheet designed to provide basic information about the NPI, including the three different ways to apply for your NPI is available at http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/EnrollmentSheet_WWWWH.pdf.  Whatever method you use to obtain your NPI, be sure to keep this information, share it with your health care partners, and update your information with NPPES whenever any of the information used to get your NPI changes.

Starting May 23, 2007, the NPI will replace all of your existing provider numbers that you use to bill Medicare, Medicaid, and other health care payers.  Although this date is still a year away, you should begin sharing this information with Medicare, other payers, and your other health care partners in order to make the transition to NPI as smooth as possible. 

For more information about the revised provider enrollment process, please contact your Medicare contractor or go to http://www.cms.hhs.gov/MedicareProviderSupEnroll.

More News:

Beginning May 1, 2006, the Centers for Medicare & Medicaid Services (CMS) announces the capability for health industry organizations to submit health care providers' applications for National Provider Identifiers (NPIs) to the National Plan and Provider Enumeration System (NPPES) via Electronic File Interchange (EFI). With EFI, a CMS-approved health industry organization can submit a health care provider's NPI application data, along with the application data of many other health care providers, in a single electronic file in a CMS-specified format.

EFI is an alternative to health care providers having to apply for their NPIs via the web-based or paper application process. After the NPPES processes a file, it makes available to the organization a downloadable file containing the NPIs of the enumerated health care providers. Interested health industry organizations should avail themselves of the EFI materials available from the CMS NPI page (http://www.cms.hhs.gov/NationalProvIdentStand/) and from the NPPES page (https://nppes.cms.hhs.gov) before downloading and completing the Certification Statement (available at https://nppes.cms. hhs.gov) and registering as EFI Organizations. A completed Certification Statement must be approved by CMS before an interested health industry organization can participate in EFI. (CMS Message 200605-04)

NPI Tip - When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI. CMS has released three new educational products on the National Provider Identifier (NPI):

Guidance for Organization Health Care Providers Who Apply for National Provider Identifiers (NPIs) for Their Health Care Provider Employees" Tip Sheet-- contains helpful information for organization health care providers who wish to apply for NPIs, or submit updates using the NPPES web-based process, on behalf of their employed health care providers. This is NOT the EFI process.

Tips for Health Care Professionals - Preparing Your Office Staff for NPI" Tip Sheet - provides basic steps to prepare your office staff, and your business, for NPI implementation.

"NPI Overview" PowerPoint Presentation - this presentation was presented by a CMS staff member at a recent WEDI meeting and contains basic information on the NPI that is suitable for self education, as well as training purposes. Visit the Educational Resources page on CMS' NPI website at http://www.cms.hhs.gov/NationalProvIdentSt and/04_education.asp to view these new products. (CMS MESSAGE 200604-17)