Why, When, and How to Get an NPI Number
September 08, 2023
September 08, 2023
Wellness professionals constantly deal with codes and identifiers for regulatory, billing, and administrative purposes. So, you’d be forgiven if it feels daunting to add another number to the list in the form of a National Provider Identifier (NPI). However, it’s important to understand the significance of the NPI number, especially as your practice grows.
If you’re unfamiliar with NPI numbers, you likely have questions about who needs an NPI number, how to get an NPI number, how long it takes to get an NPI number, and more. This article covers everything you need to know about NPI numbers — from what they are to how they relate to HIPAA to the different methods you can use to get one of your own. Keep reading to boost your National Provider Identifier IQ!
The Centers for Medicare & Medicaid Services (CMS) introduced the National Provider Identifier system in the United States in the late 2000s. The intent was to standardize the identification of healthcare providers across various systems, while improving the accuracy and efficiency of electronic transactions in the industry.
NPI numbers accurately identify care providers during electronic transactions, billing, and claims processing. They have an interdependent relationship with HIPAA (Health Insurance Portability and Accountability Act).
NPI numbers serve as unique identifiers to help with accurate data exchange and billing processes. HIPAA sets the standards for safeguarding patient information and ensuring the privacy and security of sensitive health data, including information related to NPIs. As a health and wellness professional you need to navigate both NPI usage and HIPAA compliance to maintain the integrity of client care and data protection.
Here is an example of where to enter your NPI number in the Practice Better portal:
Storing your NPI number in the Practice Better portal under Settings > All Settings and Preferences > Insurance Billing ensures your NPI number is automatically included in CMS 1500 forms, saving you precious time on tedious paperwork.
According to CMS, there are three main benefits associated with having an NPI number:
NPI numbers are available to providers involved in patient care and engaged in electronic transactions related to healthcare services. You can get an NPI number if you provide care as defined in 45 Code of Federal Regulations (CFR) 160.103. Here are a few guidelines to keep top of mind:
If you’re unsure whether you need an NPI number, you can research your specific state and industry regulations to help you determine the answer.
To contextualize this, imagine you operate a naturopathic clinic offering a range of services delivered by licensed professionals, including acupuncture, herbal medicine, nutritional counseling, and wellness workshops. From an administrative perspective, treating each of these as subparts allows you to track services, bill accurately, and provide a seamless experience to your clients. In this case, each subpart would need its own unique NPI to make for easier electronic transactions and accurate record keeping.
Yes, you can apply for an NPI number without having a professional license. The NPI system was designed to create a standardized identifier for accurate data exchange, coordination of benefits, claims processing, and billing. Not all individuals involved in those activities are licensed providers.
Three are three ways to apply for an NPI number: online, by mail, or through a third party.
The above summary only covers the high-level steps involved. If you’d like a more comprehensive step-by-step walkthrough of how to apply for an NPI number online, CMS provides one over here.
If you’d like to request a hard copy application rather than printing off your own, you can do so through the NPI Enumerator, call 800-465-3203 or TTY 800-692-2326, or send an email to email@example.com.
PS: If you’re wondering about the NPI number application cost, note that applying for an NPI number through the official NPPES website is free.
You should receive your NPI number within 15 days, although in some cases it may come through even faster. If the NPPES needs to conduct additional data verification, it can take up to 30 days to get an NPI number.
Your submission confirmation page will provide you with contact information if you need to follow up on your application.
NPI numbers aren’t just helpful for regulatory agencies. They’re also a valuable tool for wellness professionals to promote easier information exchange, more accurate billing, and smoother continuity of care between referral partners. Even if you don’t currently offer insurance-covered services, applying for an NPI number can help to future-proof your practice as it grows.
Now that you’ve read this article you should have a good sense of the steps you need to take to get an NPI number – for yourself or your organization. If you still have questions around how to get an NPI number, or anything else NPI-related, check out the comprehensive list of frequently asked NPI questions.
Practice Better is the complete practice management platform for nutritionists, dietitians, and wellness professionals. Streamline your practice and begin your 14-day free trial today.