National Provider Identifier: The next HIPAA challenge

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HIPAA will continue to haunt healthcare for some time. Walter Suarez, MD, president and CEO of the Midwest Center for HIPAA Education and Peter Barry, co-chair of the National Provider Identifier (NPI) working group, summarized one of the most pressing challenges: the NPI at “Implementing the National Provider Identifier: The Next HIPAA Challenge” on Tuesday at the Healthcare Information Management Systems Society (HIMSS) annual meeting in San Diego.
   
The NPI is a unique 10-digit identifier for each provider or sub-part, and it will be required on eight named HIPAA transactions after May 2007. Barry described both types of NPIs; an individual NPI can be assigned to an individual provider, and an organizational NPI applies to legal entities such as corporations or partnerships.
   
Hospitals must obtain NPIs for subparts and referring physicians and labs and determine the impacts on contracts. Other critical steps are to remediate internal processes, systems and data and manage external associates and vendors.
   
Suarez divided NPI implementation into four phases. Currently, most providers are in the first phase—without an NPI; however, some payors are ready for phase two, which accepts transactions with both an NPI and legacy identifier but not sole NPI transactions. Phase three follows; providers can begin to accept NPI-only transactions. And by May 23, 2007, transactions must include only the NPI as the identifier. Suarez predicted that NPI implementation will be a complex process that extends beyond the May 23, 2007, deadline.