MCC 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 MCC.
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 Date of Birth
||State of Birth (if Country of Birth is U.S.)
|Country of Birth
||SSN or Other Proof of Identity
||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.
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 Complete Care
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 MCC.