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National Provider Identifier
Purpose
The National Provider Identifier (NPI) is a unique health care provider number used to distinguish individual practitioners or provider organizations during standard electronic health care transactions. The 10-digit number assigned through a single, national enumerator is intended to simplify the exchange of health care data by eliminating the need for health care providers to use different identification numbers to identify them when conducting standard transactions with multiple health plans.
Type-1 NPI numbers are assigned to individual practitioners. Type-2 NPI numbers are assigned to provider organizations or their sub-parts. At this time, MACSIS does not require providers to report Type-1 NPI numbers on their claims.
How to Apply for an NPI
Consistent with the federal NPI requirement, all MACSIS providers must obtain a Type-2 NPI(s) and provide this information to their contracting board. Please refer to NPI application instructions for more information. Regarding approval for claim file submission, the impact to providers will depend on their claim filing status:
MACSIS providers who submit claims electronically
- You are required to include your NPI information on your incoming claim files and must be approved to do so. Similarly, you will receive NPI information on your electronic remittance files.
- Providers will still be assigned a UPI (Unique Provider Identifier) to use as their MACSIS submitter ID on their incoming claim file.
- You are still required to obtain a Type-2 NPI and provide that information to your board. The board must then notify MACSIS staff that your claim status is either "funded/no claims" or "manual entry" (by board) so the MACSIS staff will know you are not expected to be approved for NPI-compliant claim file submission.
Background Information
In September 2005, the Behavioral Health Operations Committee approved a workgroup of state and community representatives to begin assessing the impact of the NPI final rule to MACSIS. The workgroup worked very hard to raise awareness of the federal requirement and to encourage MACSIS providers to obtain NPIs accordingly. By December 2007, more than 99% of MACSIS providers had obtained an NPI.
One of the first deliverables of the workgroup was to outline the options available to existing MACSIS providers when applying for an NPI(s) and clarify the impact of their decisions on existing identifiers and rate structures. This resulted in the development of an NPI Decision Tool and an NPI Overview educational presentation.