N ational P rovider I dentifier Western Highlands Network

National Provider Identifier What is NPI Why do we need the NPI Who can apply How to obtain an NPI How to register with WHN How to bill WHN Sources

What is NPI The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for health care providers The NPI is a 10-digit unique identifier issued by the National Plan and Provider Enumeration System (NPPES)

Why do we need the NPI The NPI will replace health care providers identifiers in HIPAA standard transactions. This includes Medicare, Medicaid, and LME legacy identifiers. It doesn’t ensure licensure or credentials; guarantee payment, enroll a provider, or require a provider to conduct HIPAA transactions.

Who can apply All health care providers. A health care provider can be an individual or organization that renders health care as defined by 45 CFR

How to obtain an NPI Apply for an NPI through the National Plan and Provider Enumeration System (NPPES)

How to register with WHN Two Methods Send a copy of your Medicaid registration with NPPES certificate Or Send the WHN NPI Registration Form and NPPES certificate

How to register with WHN (cont) Legacy provider identifier Medicaid or LME Provider Number NPI Taxonomy Physical address Zip +4 Used for mapping solutions

How to bill WHN CMS 1500 (08/05) 837 Direct Data Entry Explanation of Benefits

CMS 1500 (08/05) Instructions published in NC Medicaid Special Bulletin, December 2006, New Claim Form Instructions Effective Jan 1, 2007 Must submit claims on CMS1500 (08/05) by April 1, 2007 NPI Implementation May 18, 2007

837 WHN will follow Medicaid 837 requirements A WHN 837 Companion Guide is available Replace legacy provider identifiers with NPI Adding Taxonomy Adding Zip+4 NLT May 18, 2007

Direct Data Entry Under development NPI Taxonomy Zip+4

Explanation of Benefits Under Development

Information Sources CMS NC Division of Medical Assistance NPPES WHN (828) ext WEDI