The latest on the NPI Directory & what you NEED to know

Q: I’ve heard that Centers for Medicare and Medicaid Services (CMS) plans to publish a National Provider Identifier (NPI) directory, is this true?

A: Yes. CMS has announced the intent to publish a NPI directory sometime after June 30, 2007.

Q: Will CMS be publishing all of the fields that were completed on the NPI application?

A: No, not all fields will be published.

Q: Will CMS be publishing my personal identifier information?

A: When completing the NPI application, in the Box C: Other Provider Identification Numbers section, there are various optional fields in the right-hand column. These fields will be used to link to your previous, “old” provider numbers for each of your current, participating insurance plans, if you provide the information through this system. The CMS web directory will share your old and new NPI number, exactly as you might have entered this information. However, the concern has been raised, that some plans historically requested the physician to use their private information as the previous numbers, such as your social security number or tax ID numbers. Therefore, ArMA strongly recommends physicians log-in to https://nppes.cms.hhs.gov to review each of these optional fields under the Box C: Other Provider Identification Numbers section to be certain the data entered is indeed information that you desire to become public. CMS does not intend to publish the personal identifier information from the other areas of the application, only the Box C: Other Provider Identification Number section is raising alarm for distribution of potential private data.

Q: Is there an Arizona physician NPI directory available now?

A: Yes, the ArMA web-based NPI directory is available NOW, with over 1500 names and is updated weekly. ArMA members are entitled to list their NPI information for free, just click here to access a form ArMA NPI Form. You may access the ArMA web-based NPI directory at anytime by accessing this link ArMA NPI Directory.

Q: Does every physician need a NPI number?

A: Most physicians need to obtain a NPI. If you plan to submit any claims, write prescriptions or prescribe DME, the NPI will be requested. It is advised to obtain the NPI; it will be used by many aspects of health care.

Q: I’ve heard the NPIs are delayed, is this true?

A: No, this is not entirely correct. The use of the NPI numbers has not been delayed, the enforcement has been shifted to May 2008. CMS has actively continued with the implementation of the use of the NPI numbers on the new CMS 1500 (08/05) form, and other insurance plans are expected to follow soon. In order to process claims, the NPI numbers will be reported on 4 areas of the claim form.

Q: Do I need one or two NPI numbers?

A: The NPI numbers are typically assigned as follows: One NPI for EACH individual physician and a second NPI number for the practice corporation based upon the tax EIN. There are of course, additional options, this is just the more common practice scenario.

If you have further questions as this new provider number system is implemented, contact Connie McHugh, associate vice president for Membership & Accreditation, at 602-347-6915 or cmchugh@azmedassn.org. Future educational sessions are planned to assist with the proper use of the NPI and claim form processing.