National Provider Identifier (NPI) Information

As a result of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the federal Department of Health and Human Services mandated the use of the National Provider Identifier (NPI), which is a standard unique identifier for health care providers. The purpose of this page is to provide information and tools to keep providers informed throughout the Department of Public Welfare's implementation of NPI. Watch for updates and additional resources on this page, in Provider Quick Tips, Medical Assistance Bulletins and Remittance Advice Banner Pages.

Test NPI Only Now

Pennsylvania Department of Public Welfare (DPW) strongly recommends that, prior to May 23, 2008, health care providers submit their HIPAA electronic transactions using NPI only after they have transmitted both an NPI and legacy identifier and the NPI has crosswalked successfully. This will ensure that the claim was processed correctly. Please be sure the NPI submitted is registered with DPW prior to May 23, 2008, or the claim will not process. If your claim is rejected, please read the error status codes and refer to MA Bulletin 99-07-20.

DPW's NPI Contingency Plan

HIPAA Standard Transactions (Other than Pharmacy)

*Note: NPI is validated with this scenario and edits are applied if no match found.

Pharmacy (NCPDP) Claims

Please note that the registration deadline of April 16, 2007, is suspended. However, providers should continue to pursue compliance with the NPI initiative. CMS has stated that the contingency plan does NOT mean that providers have additional time to obtain an NPI.

Additional information provided by CMS:

Press release

Complete text

Newly posted Frequently Asked Questions

Legacy Dual Strategy Fact Sheet

Please Note: Dissemination of Data from the National Plan and Provider Enumeration System (NPPES) was made available in September 2007. Additional information can be found at the following link: http://www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp

Additional NPI Resources

MA Bulletins - Medical Assistance Bulletins related to NPI.

NPI Registration - Form and instructions related to the paper registration of NPI information with DPW.

Provider Quick Tips - Provider Quick Tips related to NPI.

Presentations - Presentations related to NPI.

NPI Questions - Answers to questions that MA providers frequently ask about the National Provider Identifier (NPI).

NPI Teleconference Questions and Answers - Answers to questions asked at the conclusion of the National Provider Identifier (NPI) Awareness for Electronic Billers teleconferences.

If you need to contact someone with a specific question about NPI please complete the Contact OMAP form.

Provider Type and Specialty to Taxonomy Crosswalk - The following table was created to assist providers in selecting the taxonomy codes that correspond to their existing provider types and specialties. When registering your NPI with the Department of Public Welfare you must choose a taxonomy from this crosswalk that matches your provider type and specialty. In most cases the Department of Public Welfare will need the taxonomy code(s) associated with your NPI in order to appropriately process electronic claims for payment.

Atypical Provider Types and Specialties - The Centers for Medicare and Medicaid Services (CMS) defines atypical providers as providers that do not provide health care. This is further defined under HIPAA in Federal regulations at 45 CFR 160.103. Taxi services, home and vehicle modifications, and respite services are examples of atypical providers reimbursed by the Medicaid program. Even if these atypical providers submit HIPAA transactions, they still do not meet the HIPAA definition of health care and should not receive an NPI number. Therefore, atypical providers will not be on the DPW Taxonomy Crosswalk posted on the DPW NPI Web site.

There are times when a health care provider will deliver an atypical service at a health care service location and a NPI number must be used. For example, a nursing facility is a health care provider; however, the facility operates an adult day care center at the same service location. The adult day care center does not provide direct health care services and would be considered an atypical provider. The nursing facility must use a NPI even though the service the claim is generated for is an atypical (non-health care) service.

Still Cannott Find Your Provider Type and Specialty? If you do not find your provider type and specialty on either the crosswalk or the list of atypical provider types and specialties please call the provider inquiry line.

Center for Medicare and Medicaid Services (CMS) - Learn more about NPI and how to apply by visiting the CMS Web site. A countdown clock is available on this page to remind health care providers of the number of days left before the compliance date; bookmark this page as new information and resources will continue to be posted.

National Plan and Provider Enumeration System (NPPES) - The National Plan and Provider Enumeration System (NPPES) was developed by the Centers of Medicare and Medicaid Services (CMS) to assign the NPI to eligible health care providers. The NPPES will also store the information about enumerated providers. Providers may apply through a web-based application process at NPPES.

Fox Systems Inc. - CMS contracted with FOX Systems, Inc. to be the NPI enumerator. As the enumerator, FOX Systems, Inc. is responsible for processing NPI applications and updates and maintaining a helpdesk to assist with the NPI application process. Providers may prepare a paper application and send it to Fox Systems. A copy of the application, including the Enumerator's mailing address is available at NPPES. Providers may call FOX Systems, Inc. for a copy. The phone number is 1-800-465-3203 or TTY 1-800-692-2326.

Workgroup for Electronic Data Interchange (WEDI) - Workgroup for Electronic Data Interchange (WEDI) is a health care industry group that has a formal consultative role under the HIPAA legislation. WEDI also sponsors SNIP. SNIP (Strategic National Implementation Process) is a WEDI program for helping the health care industry identify and resolve HIPAA implementation issues. For more information, visit the WEDI Web site.