All healthcare providers can now apply for their National Provider Identifier (NPI). The NPI will replace the legacy health care provider identifiers in use today in standard healthcare transactions and paper claims.

All HIPAA covered entities except small health plans must begin using the NPI on May 23, 2007. For additional information, and to complete an application, visit https://nppes.cms.hhs.gov on the web.

NPI reference tools are available on the CMS website: http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage

First Health’s Status on the NPI

First Health is actively updating internal systems to accept, transmit, and store NPIs.
To date our accomplishments include the ability to:

• Receive claims from providers with the NPI when it is accompanied by their Federal Tax ID Number.
• Support dual usage until 5/23/07.
• Store NPI numbers on claims submitted by providers.
• Accept the New CMS 1500 claim form including NPI values.

It is important to obtain your NPI numbers and then to share them. Providers are encouraged to contact their Provider Representative to share and validate their NPIs.

Please continue to monitor the website for further updates and progress regarding our NPI compliance initiative. First Health expects to be fully compliant on or before the compliance date of May 23, 2007.

What First Health Providers Should Do NOW with Identification Numbers on Claims

The NPI is not required on claims and other transactions until May 23, 2007.

The Federal Tax ID will always be required for the billing provider on claim transactions. This means that the Provider who has obtained an NPI, may submit their NPI as the Primary Identifier and the Federal Tax ID must be submitted as Secondary Identifier.

First Health requires the Billing Provider’s Federal Tax ID number to be submitted in Loop 2010 AA REF 02 segment with an EI qualifier when the provider submits an NPI number as the primary identifier (NM109). No other provider loops (e.g. Rendering Provider, Referring Provider, Attending Provider, etc.) require the Federal Tax ID.

Please watch our website for further updates or contact your First Health Provider Relations Representative.

Frequently Asked Questions