NAACCR’S National Provider Identifier Resource Kevin Henry Frank Boscoe Chris Johnson NAACCR GIS Committee June 10, 2008

The National Provider Identifier (NPI)? What is NPI? 10-position, intelligence-free numeric identifier (10-digit #). NPI is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard A unique identification number for covered health care providers. Why NPI? Developed for efficient electronic transmission of health information by the Centers for Medicare & Medicaid Services (ends paper transactions). Past healthcare provider codes did not meet criteria for national standards. Identifies health care providers on a claim transaction. replaces other identification numbers used by health providers.

The National Provider Identifier (NPI) Who has an NPI? When is NPI Mandatory? All health care providers: includes any person or organization that provides healthcare, bills or is paid for health care NPI Entity Type Code 1. Individual Persons Pharmacists Physicians Dentists Nurses 2. Group Health Care Providers Hospitals Clinics Treatment Centers HMOs After May 23, 2008 health care providers may only use their NPI in standard transactions. Where is the NPI file ? NPI downloadable from: Search NPI Registry online from:

Important NPI Data Elements The National Provider Identifier (NPI) Important NPI Data Elements Billing Address Physical Address Entity Type Code (Individual, Organization) Provider Organization Name Provider Individual Name Provider Phone # Taxonomy Codes Colon & Rectal Surgery - 208C00000X Gynecologic Oncology - 207VX0201X Clinical Pathology - 207ZC0006X Individual Psychiatric Unit - 273R00000X Military Acute Care Hospital M2000X Organization Example: Taxonomy Codes (1-15)

NAACCR Standards & NPI NAACCR introduced standards for collecting NPI (v. 11. April 2006) The National Provider Identifier (NPI) Most NAACCR NPI data fields for have equivalent pre-existing fields NPI--Archive FIN (Item # 3105) NAACCR NPI Fields NPI—Following Registry (Item # 3105) NPI– Institution referred from (item #2415) NPI– Institution referred to (item #2425) NPI-- Physician 3 (item #2495) NPI-- Physician 4 (item #2505) NPI– Physician-Follow-up (item #2475) NPI– Physician-Managing (item #2465) NPI– Physician-Primary Surg (item #2485) NPI– Registry ID (item #45) NPI– Reporting Facility (item #545)

NPI Implementation Among NAACCR Registries NAACCR Semantic Interoperability Work Group (SIWG) examining NPI data. Some observations: The National Provider Identifier (NPI) (Acos-Fin-Fan-NJ State) - As of March 2008 very little being done with NPI at registries. - Louisiana & Idaho Cancer Registry – completed a linkage for facility codes which required significant manual intervention (Louisiana posted file on their website). - Florida has decided to request reporting source information updates is requiring that each reporting source respond back with their NPI. -New Jersey: creating a master physician list & (state facility code)-NPI conversion file. -Numerous updates and changes in initial releases (Taxonomy Codes, addresses). Problems/Concerns -Multi-practice locations, multiple NPI numbers for certain facilities. -Verification of business address versus practice location address. -Accuracy of taxonomy codes.

Important NPI Data Elements The National Provider Identifier (NPI) NPI Geocoding Project NAACCR GIS Committee geocoded the entire NPI file. NPI Input (2,439,058) Geocode Value Added Fields

The National Provider Identifier (NPI) NPI Input (2,439,058) Geocode Value Added Fields Provider 1 st line Physical Address Provider 2 nd line Physical Address City State Zip Code Address Elements

The National Provider Identifier (NPI) NPI Input (2,439,058) Value Added Fields New Jersey State Cancer Registry Geocoder Probabilistic Matching Methods (Integrity Geolocator) 2005 GDT (Tele-Atlas) Street Files NAD 83, decimal degrees Match Rate: 94% (street address matches only) Geocode

The National Provider Identifier (NPI) NPI Input (2,439,058) Value Added Fields Geocode Latitude, Longitude Census Tract Quality Control Fields Geocoding Match Type Month-year of NPI File Geocoding data source Year of geocoding base layer Month-year record geocoded

The National Provider Identifier (NPI) NPI Input (2,439,058) Value Added Fields Geocode NPI file will geocoded every year

The National Provider Identifier (NPI) Future Enhancements Add Coordinate Quality Fields Add Census Block Codes Routines for cancer registries to extract the data they need (e.g. SAS, Visual Basic)

The National Provider Identifier (NPI) Possible NPI Geographic Applications Practice Patterns Driving Distance to facility/treatment Closest Facility versus the distance to the facility they used How often do patients bypass nearer facilities for their care Issues of quality and access

The National Provider Identifier (NPI)