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National Provider Identifier
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National Provider Identifier
On Jan. 23, 2004, the Department of Health and Human Services (HHS) published the Health Insurance Portability and Accountability Act (HIPAA) Final Rule for the National Provider Identifier (NPI). This rule adopts the NPI as the standard unique identifier for health care providers. The final rule goes into effect May 23, 2008, and affects both individual providers (e.g., physicians, nurse practitioners and pharmacists) and organizational providers (e.g., hospitals and pharmacies) who conduct HIPAA-standard electronic transactions.
The goal of the NPI is to simplify the administration of the health care system and enable efficient electronic transmission of health information. Beginning May 23, 2008, providers should comply by submitting the appropriate NPI on all HIPAA-standard electronic transactions.
Once you have obtained your NPIs, it is equally important that you contact your practice management system vendor and electronic claims clearinghouse or billing service in order to determine the steps that need to be taken in order to transmit your NPIs on your electronic TRICARE claims.
PGBA’s new NPI edits will be enforced at the EDI (electronic) Gateway. Claims failing these edits will be electronically returned to the submitter with the appropriate messaging. These rejected claims will not be processed to denial, and will not create EOBs/remittances. Compliance date begins May 23, 2008.
Individual providers (Type 1) and Organizational providers (Type 2) can post their NPIs with us through MyHMHS for Providers by clicking on the link NPI Registration and Maintenance(Business Offices). You need to be sure that all of your NPIs have been registered with us.
PGBA also has a Provider NPI "Update and Maintain" option on www.mytricare.com. Contact the PGBA EDI Help Desk if mapping assistance is needed.
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