HIPAA Resource Center for Providers

Our HIPAA resource center includes the following important information for health care providers:

  • Molina’s HIPAA readiness status and implementation materials;
  • Information on how to conduct HIPAA transactions with Molina;
  • Links to other helpful HIPAA websites.
 

Learn More About HIPAA - Helpful HIPAA Websites

The websites below have information related to HIPAA-the Health Insurance Portability and Accountability Act of 1996. HIPAA topics include transactions, code sets, privacy of health information, and security standards.

 

  • Unique Identifiers

    Molina has implemented the HIPAA NPI requirements. Beginning May 23, 2008, HIPAA standard transactions must include NPIs. No legacy identifiers (other than the billing/pay-to provider's Tax ID number) may be included on HIPAA standard transactions as of May 23, 2008. Non-compliant transactions will be rejected by Molina.

    NPI Overview

    Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Secretary of Health and Human Services (HHS) was required to adopt a national standard unique identifier for covered healthcare providers. On January 23, 2004, the Secretary published the Final Rule that adopted the National Provider Identifier (NPI) as the standard unique identifier. The Centers for Medicare and Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to identify providers and assign NPIs.

    The NPI is a ten-digit number and must be used on HIPAA standard electronic transactions, such as claims, to identify a provider. Beginning on May 23, 2005, healthcare providers could apply for their National Provider Identifier (NPI). Health care providers and most health plans were required to comply with the NPI Rule by May 23, 2007.

    How to Apply for your NPI

    Providers may apply on-line at the NPPES web site.

    Information Required to Obtain your NPI

    For providers who are individuals:

    Provider Name Provider Date of Birth
    Provider Gender State of Birth (if Country of Birth is U.S.)
    Country of Birth SSN or Other Proof of Identity
    Mailing Address Practice Location Address and Phone Number Taxonomy (Provider Type) State License Information *
    Contact Person Name Contact Person Phone Number and Email

    * (required for certain taxonomies only)

    Note: Taxonomy codes describe provider type/classification/specialization of individual and organization health care providers. A complete list of taxonomy codes is available from the Washington Publishing Company.

    Providers (Type 1) who will be required to obtain an NPI include physicians, non-physician healthcare practitioners, other suppliers and certified providers such as institutions, home health agencies and skilled nursing facilities. Each individual practitioner will receive one NPI. However, an organizational provider (Type 2) may obtain an NPI for each of its subparts.

    A subpart can be considered a separate physical location of an organization healthcare provider, member of a chain or an organization healthcare provider separately licensed or certified. Review the information below to determine if you need to obtain NPI's for subparts.

    Overview
    Subparts
    Fact Sheet
    Decision Tree for Determining NPI Subparts

    NPI Educational Resources and Tips

    CMS has developed a variety of educational resources to help providers obtain and use their NPI. Click to access CMS's NPI educational resources.

    How to Report and Use your NPI with Molina Healthcare

    Please contact Molina’s HIPAA Program Office or call our HIPAA Provider Hotline at 1-866-MOLINA2 (1-866-665-4622) if you need more information regarding how to register and use your NPI when conducting HIPAA transactions with Molina.

 

For general business questions: Please contact your Molina Customer Care representative.

Ask the HIPAA Help Team > HIPAA Contact Form 

Please fill out the form below as completely as possible. When you are finished, press the "Submit" button at the bottom of this page. If you indicate that you would like a response, we will contact you. If you need a response urgently, please call Molina using the contact numbers above.

Please do not include private information, such as a Member ID Number or Social Security Number, or medical information, as this is not a secured form. Form fields with a red asterisk (*) are required.

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