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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

National Provider Identifier (NPI)

What is an NPI?

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA.

The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The provider’s NPI will not change and will remain with the provider regardless of job or location changes.The NPI must be used in lieu Medicare legacy IDs (UPIN, OSCAR, PIN, and National Supplier Clearinghouse or NSC). In North Carolina, the NPI replaces the Medicaid Provider Number (MPN).

As outlined in the federal regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. Full implementation of NPIs took place on May 1, 2009.

Request an NPI

Individual providers and healthcare provider organizations can obtain NPIs by visiting the National Plan & Provider Enumeration System (NPPES) web page

NPI and Taxonomy

For all claims (except pharmacy) that are submitted electronically, a taxonomy code must be included for the billing provider.

Detailed information about Taxonomy codes can be found in the NCTracks Provider Claims and Billing Assistance Guide. (Section 6) as well as at these links:

For placement of data on the 837 transaction, consult the X12 Implementation Guide External link

NPI and Carolina ACCESS

If a Carolina ACCESS beneficiary is referred to another provider, the NPI of the referring Carolina ACCESS provider must be included on all claims. If the beneficiary is enrolled with an individual provider, obtain the individual provider’s NPI.  If the individual is enrolled with the healthcare practice, use the practice’s NPI.

To determine whether the beneficiary is linked to the individual provider (e.g., Dr. Who) or the provider’s practice (e.g., Tardis Medical Group), refer to one of the verification methods outlined on pages 47-48 of the Provider Claims and Billing Assistance Guide .

Atypical Providers

"Atypical" providers are providers who do not provide healthcare services and will not be issued NPI numbers. Atypical providers are individuals or businesses that bill Medicaid for services rendered but do not meet the definition of a healthcare provider according to the NPI FInal Rule 45 CFR 160.103 (for example, non-emergency transportation providers). Atypical providers will use provider identification numbers generated by NCTracks to file their claims.

Medicaid Bulletins about NPI

Frequently Asked Questions (FAQs)

The Center for Medicare & Medicaid Services (CMS) has collected hundreds of FAQs covering all aspect of NPI.

CMS Information

 

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