Emdeon Business Services is a leading provider of business, technology and information solutions that transform both the financial and clinical aspects of healthcare delivery. At the core of Emdeon's vision is its commitment to connecting providers, payers, employers, physicians and consumers in order to simplify business processes and improve healthcare quality. Emdeon processes billions of transactions each year on behalf of over 300,000 physicians, hospitals, dentists, clinical laboratories, and pharmacies.
Because Emdeon has played a vital role in assisting its healthcare trading partners comply with the administrative simplification requirements of the Health Insurance Portability and Accountability Act (HIPAA), many trading partners are seeking our assistance with the implementation of the National Provider Identifier (NPI). Recognizing this, the Workgroup on Electronic Data Interchange (WEDI), through the National Provider Identifier Outreach Initiative (NPIOI), invited Emdeon to comment on the NPI and its effect on electronic healthcare transactions.
Emdeon is committed to meeting HIPAA’s requirements regarding the NPI and has dedicated significant resources toward assuring the readiness of our systems for NPI implementation. In fact, Emdeon is capable of accepting NPI on applicable, HIPAA transactions and transmitting NPI to payers with NPI-ready systems.
What is NPI?
The NPI is a permanent, ten-digit, intelligence-free identification number assigned to each healthcare provider by the National Plan and Provider Enumeration System (NPPES), an electronic enumeration system set up by the Centers for Medicare & Medicaid Services (CMS).
Why is the NPI required?
The adoption of NPI is intended to reduce costs and improve efficiency by eliminating the need for healthcare providers to maintain, track and use multiple identification numbers assigned by various health plans.
To meet HIPAA’s simplification provisions, NPI are mandatory for all HIPAA transaction sets. The legacy provider IDs assigned by payers may no longer be required.
Who is affected by NPI?
All covered healthcare providers are required to use NPI in all standard transactions no later than May 23, 2007. The Final Rule and CMS define a covered healthcare provider as a person or organization that:
a) provides medical or health services and any other person or organization that furnishes, bills, or is paid for healthcare in the normal course of business;
AND
b) transmits health information in an electronic format in connection with transactions for which the Secretary of Health and Human Services has adopted a standard.
Examples of covered healthcare providers include:
- physicians and other practitioners
- hospitals and other institutional providers
- suppliers of durable medical equipment, healthcare supplies, prosthetics, orthotics, etc.
- pharmacies and pharmacists
- group practices
- HMOs, if they also provide healthcare
