In accordance with the Health Information Portability and Accountability Act (HIPAA) of 1996, the Secretary of Health and Human Services (HHS) published a final rule in January 2004 adopting a new identifier - known as the National Provider Identifier (NPI) - to be used within the healthcare industry.
Healthcare providers must obtain an NPI and use it when submitting HIPAA standard electronic transactions including, but not limited to:
- Claims and encounter information (837 I/P)
- Payment and remittance advice (835)
- Member eligibility inquiry (270)
- Claims status and inquiry (276)
The 10-digit NPI replaces other provider identifiers, such as HMSA provider numbers and the Medicare UPIN. Qualified providers must begin using their NPI in electronic transactions beginning May 23, 2007.
The U.S. Department of HHS through the Centers for Medicare and Medicaid Services (CMS) is responsible for oversight and management of the NPI system. CMS has contracted with Fox Systems to operate the National Plan and Provider Enumeration System (NPPES or "the Enumerator"), a computer system that will process applications and updates, ensure the uniqueness of the healthcare provider and generate NPIs.
Get it.
HMSA encourages covered entities to apply for an NPI immediately if they have not already done so. There are three ways to apply for an NPI:
- Complete the online application at the NPPES website: https://nppes.cms.hhs.gov.
- Call 1 (800) 465-3203 or 1 (800) 692-2326 (TTY) to request a hard-copy application from NPPES.
- Permit an organization - known as an electronic file interchange organization (EFIO) - to obtain an NPI on his or her behalf through an electronic file interchange (EFI). Refer to www.cms.hhs.gov - National Provider Identifier (NPI) for more information about bulk enumeration.
Share it.
It is critical providers obtain an NPI and share this information with HMSA. If you add or change your NPI enumeration, it is also important to share this information with HMSA.
Use it.
Use the NPI(s) in the HIPAA electronic transactions that your office uses.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |