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Home > Medical Professionals > Health Policy and Government Relations > Regulatory Issues > National Provider Identifier (NPI) Rule Effective May 23, 2007

National Provider Identifier (NPI) Rule Effective May 23, 2007

As part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, an NPI is required for all “covered entities”, which include health care providers who conduct transactions in electronic form, health care clearinghouses and health plans. NPIs will need to be used by covered entities on all HIPAA covered transactions that call for health care provider identifiers to be in compliance with this rule, which is effective on May 23, 2007.

However, because so many providers have not obtained NPIs as yet, for a period of 12 months after the NPI compliance date (May 23, 2008), the Centers for Medicare and Medicaid Services (CMS) will not impose civil monetary penalties on covered entities who can show “good faith efforts” in complying with this rule by deploying contingency plans.  Old identifiers are permitted to be used during the transition to NPIs. 

Complaints can be filed against a covered entity and payment disruptions can occur if the entity is not making a good faith effort to comply with this rule in the next 12 months.

CMS has not announced fee for service contingency plans as yet.  Additional NPI information is available on the CMS web site at http://www.cms.hhs.gov/NationalProvIdentStand. 

Also, an individual NPI is required in order to participate in the Physician Quality Reporting Initiative (PQRI), which will provide a bonus payment of 1.5% to all physicians who voluntarily report on at least three PQRI quality measures beginning July 1, 2007.  The bonus payment will apply to all claims submitted by the reporting physician.  Additional information for the PQRI is available on the CMS web site at http://www.cms.hhs.gov/PQRI and on the SVS web site.