1. NPI Enumeration Strategies Gail Kocher, Highmark Inc January 11, 2006
National HIPAA Audioconference: Analysis of the National Provider Identifier
NPI Enumeration Strategies
Gail Kocher, Highmark Inc
January 11, 2006

2. Individual Practitioner
One NPI for lifetime
Required when covered entity, i.e. sole proprietorship

3. Individual Practitioner
Highly recommended for all, but specific examples, when:
A member of group professional practice
Hospital compensated or facility employed
Routinely refers patients to other Health Care Providers

4. Organizational Provider
Required for covered entity Health Care Providers when they are the
Legal entity
Subpart that would be a covered entity if a separate legal entity
Subpart that generates its own standard transactions

5. Organizational Provider Enumeration Strategy
One schema for all Payers
Requires communication between Providers and their Payers
Requires determination of business need vs. mandated need for subparts
Provider Decision
Enables Coordination of Benefits

6. Organizational Provider Enumeration Strategy
Highest level of granularity detail needed for internal business processes
Evaluate current contracts for reimbursement impacts
Determine potential contract changes for reimbursement impacts
Evaluate systems capabilities and limitations

7. Organizational Provider Enumeration Strategy
Highest level of granularity detail needed for internal business processes
Determine internal billing entity needs
Billing Provider
Returned Data e.g. remit, utilization
Determine Payer capabilities
Data supplied e.g. remit, utilization

8. Organizational Provider Enumeration Strategy
Highest level of granularity detail needed for internal business processes
Criteria for uniqueness must be met e.g.. Taxonomy, Location
Be aware of potential future HIPAA transaction impacts, e.g

9. Contact Information
Gail Kocher HIPAA Knowledge Center Highmark, Inc