Practitioners face risks in not using their NPI
by Legal and Regulatory Affairs Staff
The NPI is a unique 10-digit number assigned to every health care provider or entity that applies for it. All health care practitioners who are considered "covered entities" under HIPAA are required to obtain an NPI. Practitioners who electronically transmit health information in connection with specified transactions such as submitting health care claims and determining eligibility for a health plan are among the "covered entities."
CMS has statutory authority to issue penalties of $100 to $25,000 per violation. More immediate than the possibility of federal penalties, however, is the risk of interruptions in your cash flow. As of May 23, 2007 federal law directs payers not to process claims that lack an NPI.
If you electronically submit a claim without an NPI, your claim likely will be rejected. A practitioner then will have to go through a potentially lengthy process of notifying the payer that you have an NPI and resubmit the claims with your NPI number.
If you have not yet obtained your NPI, you may apply for one online.
If you have questions about obtaining and using your NPI, please feel free to the Legal and Regulatory Affairs Department in the Practice Directorate at 202-336-5886 or by e-mail.