tant and the two Physical Therapists must have its own NPI number

When billing on HCFA 1500 08/05:

Rendering Physician: Item Box 24J must have the rendering provider's NPI number (eg. the MD, PA or the PT)

Service Location: Item Box 32a Must have the group / practice / facility NPI number

eg. Pain No More Group's NPI number (POS: 11) ASC Surgical Center (POS: 24) Great Care Hospital (POS: 22)

So if the provider for exa

What is an NPI? NPI or the National Provider Identification number is a 10-DIGIT unique numbers. It is a combination of intelligent numbers that does not carry information about the healthcare provider such as his provider type, specialty or in what state he is practicing. This unique identifier will eventually replace all of the provider’s insurance individual provider number issued by each insurance company that he participates with. But this will NOT replace the provider’s Tax ID Number which is required on claims submission.

NPI number once issued will remain permanent to the provider regardless of change in practice location, group practice or change of job.

NPI or the National Provider Identification number has been mandated by the Federal Government through HIPAA (Health Insurance Portability and Accountability Act of 1996. This must be obtained by health providers from the Centers of Medicare & Medicaid (CMS). This mandates all covered entities effective May 23, 2007.

So Why Do I need an NPI?

1. It is a standard and unique identification number for all providers (this also eliminates all your individual insurance provider number);
2. For electronic submission of claims on HIPAA standard transactions
3. For HIPAA standard transaction on Benefits and Eligibility Inquiry
4. For HIPAA standard transaction on Claims Status Inquiry
5. For HIPAA standard transaction on Coordination of Benefits
6. NPI is also required for the new HCFA 1500 08/05

Here's the Scenario:

A Pain Management Physician's group with one Physician Assistant and two Physical Therapists.

The Physician performs interventional pain management procedures in the following location:

POS (Place of Service): 11 (Office)

POS (Place of Service): 22 (Outpatient Hospital)

POS (Place of Service): 24 (Ambulatory Service Center)

What You Need:

1. Your Pain Management group/practice/company must have its own NPI number
2. The Physician must have its own NPI number
3. The Physician Assistant and the two Physical Therapists must have its own NPI number

When billing on HCFA 1500 08/05:

Rendering Physician: Item Box 24J must have the rendering provider's NPI number (eg. the MD, PA or the PT)

Service Location: Item Box 32a Must have the group / practice / facility NPI number

eg. Pain No More Group's NPI number (POS: 11) ASC Surgical Center (POS: 24) Great Care Hospital (POS: 22)

So if the provider for exam

will remain permanent to the provider regardless of change in practice location, group practice or change of job.

NPI or the National Provider Identification number has been mandated by the Federal Government through HIPAA (Health Insurance Portability and Accountability Act of 1996. This must be obtained by health providers from the Centers of Medicare & Medicaid (CMS). This mandates all covered entities effective May 23, 2007.

So Why Do I need an NPI?

1. It is a standard and unique identification number for all providers (this also eliminates all your individual insurance provider number);
2. For electronic submission of claims on HIPAA standard transactions
3. For HIPAA standard transaction on Benefits and Eligibility Inquiry
4. For HIPAA standard transaction on Claims Status Inquiry
5. For HIPAA standard transaction on Coordination of Benefits
6. NPI is also required for the new HCFA 1500 08/05

Here's the Scenario:

A Pain Management Physician's group with one Physician Assistant and two Physical Therapists.

The Physician performs interventional pain management procedures in the following location:

POS (Place of Service): 11 (Office)

POS (Place of Service): 22 (Outpatient Hospital)

POS (Place of Service): 24 (Ambulatory Service Center)

What You Need:

1. Your Pain Management group/practice/company must have its own NPI number
2. The Physician must have its own NPI number
3. The Physician Assistant and the two Physical Therapists must have its own NPI number

When billing on HCFA 1500 08/05:

Rendering Physician: Item Box 24J must have the rendering provider's NPI number (eg. the MD, PA or the PT)

Service Location: Item Box 32a Must have the group / practice / facility NPI number

eg. Pain No More Group's NPI number (POS: 11) ASC Surgical Center (POS: 24) Great Care Hospital (POS: 22)

So if the provider for exa

ification number for all providers (this also eliminates all your individual insurance provider number);

For electronic submission of claims on HIPAA standard transactions

For HIPAA standard transaction on Benefits and Eligibility Inquiry

For HIPAA standard transaction on Claims Status Inquiry

For HIPAA standard transaction on Coordination of Benefits

NPI is also required for the new HCFA 1500 08/05

Here's the Scenario:

A Pain Management Physician's group with one Physician Assistant and two Physical Therapists.

The Physician performs interventional pain management procedures in the following location:

POS (Place of Service): 11 (Office)

POS (Place of Service): 22 (Outpatient Hospital)

POS (Place of Service): 24 (Ambulatory Service Center)

What You Need:

1. Your Pain Management group/practice/company must have its own NPI number
2. The Physician must have its own NPI number
3. The Physician Assistant and the two Physical Therapists must have its own NPI number

When billing on HCFA 1500 08/05:

Rendering Physician: Item Box 24J must have the rendering provider's NPI number (eg. the MD, PA or the PT)

Service Location: Item Box 32a Must have the group / practice / facility NPI number

eg. Pain No More Group's NPI number (POS: 11) ASC Surgical Center (POS: 24) Great Care Hospital (POS: 22)

So if the provider for exa

hysician's group with one Physician Assistant and two Physical Therapists.

The Physician performs interventional pain management procedures in the following location:

POS (Place of Service): 11 (Office)

POS (Place of Service): 22 (Outpatient Hospital)

POS (Place of Service): 24 (Ambulatory Service Center)

What You Need:

1. Your Pain Management group/practice/company must have its own NPI number
2. The Physician must have its own NPI number
3. The Physician Assistant and the two Physical Therapists must have its own NPI number

When billing on HCFA 1500 08/05:

Rendering Physician: Item Box 24J must have the rendering provider's NPI number (eg. the MD, PA or the PT)

Service Location: Item Box 32a Must have the group / practice / facility NPI number

eg. Pain No More Group's NPI number (POS: 11) ASC Surgical Center (POS: 24) Great Care Hospital (POS: 22)

So if the provider for exa

tant and the two Physical Therapists must have its own NPI number

When billing on HCFA 1500 08/05:

Rendering Physician: Item Box 24J must have the rendering provider's NPI number (eg. the MD, PA or the PT)

Service Location: Item Box 32a Must have the group / practice / facility NPI number

eg. Pain No More Group's NPI number (POS: 11) ASC Surgical Center (POS: 24) Great Care Hospital (POS: 22)

So if the provider for example performed an SI injection done in the outpatient hospital service location, your HCFA 1500 Item Box 32a must have the NPI number of the outpatient hospital. The same way if the procedure was perforemed at the ASC, you need the ASC's NPI number on box 32a.

Name of Referring/Ordering Provider: Item Box 17b Referring Provider's NPI number is placed here (this NPI number replaces UPIN after May 2007)

**It is now a good idea to start gathering NPI numbers for all your referring/ordering physicians NPI number for your new patients.

Billing Provider: Item Box 33a eg. Your Pain Management Group's NPI number

So Who are Affected with NPI? All Physicians and other medical practitioners, such as dentists, physical therapists, ophthalmologists, clinical psychologists, licensed social workers, physician assistants, nurse practitioners, nurses, chiropractors, pharmacists and all medical specialists, etc.

1. Medical Practice Groups
2. HealthCare Provider Organizations/Companies/Service Locations
3. DME (durable medical equipment) vendors
4. Hospitals, nursing homes and other institutional providers
5. Pharmacies All Health Plans (all HIPAA-covered entities) *** Small Health Plans has until May of 2008 to adopt NPI.

For your information: The Administrative Simplification Compliance Act (ASCA) mandates that all providers must submit claims by electronic submission. Certain criterias must be met if you want to submit claims by paper only or both paper and by electronic. If you qualify and allowed to file paper claims, you may use the new CMS 1500 08/05 claim form. You must begin submitting the NPI number along with your legacy number as of January 2, 2007.

May 23, 2007 is the deadline for NPI! Don't waste time!

Apply for your NPI now. There will be transition for sure. Avoid the possibility of interrupting your claims payments from payers. Review your medical practice billing system, contact a clearing house or a billing service provider or vendors to discuss NPI implementation.