Provider Notice issued 06/29/07

National Provider Identifier (NPI)

This notice is to clarify that under the final Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Provider Identifier (NPI) rule, all long-term care facilities including nursing facilities, intermediate care facilities for the developmentally disabled and supportive living facilities will be required to obtain an NPI.

NPI implements a requirement of HIPAA.  Although long-term care facilities do not submit claims to the Department for residential/facility services, NPI must be used by most HIPAA covered entities that conduct electronic transactions such as eligibility inquiries, claims status inquiries and submission for claims for non-institutional services.

The Department is announcing a contingency plan for covered entities for compliance with the NPI regulations under HIPAA.  This announcement follows the Department of Health and Human Services (DHHS) contingency plan for NPI, which was released on April 2, 2007.  Even though the DHHS contingency plan allows an additional 12 months from the May 23, 2007, implementation date for covered entities that have made a good faith effort to comply with the NPI provisions, the HFS contingency plan will periodically be assessed to determine when to enforce the NPI requirements.

When applying for your NPI, DHHS urges you to include your legacy identifiers, not only for Medicare but also for all payers.  If reporting a Medicaid number, include the associated State name. This information is critical for payers in the development of crosswalks to aid in the transition to the NPI.

Information on NPIs, including how to apply, can be found on the DHHS Web site at:

http://www.cms.hhs.gov/NationalProvIdentStand/.

Once you have obtained your NPI, you must register your NPI with the Department at the Medical Electronic Data Interchange (MEDI) Web site at www.myhfs.illinois.gov or on the Web-based application available to report NPI information.

Theresa A. Eagleson, Administrator

Division of Medical Programs