CMS issues final rule on National Provider Identifier number

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Healthcare providers and suppliers will be required to use a National Provider Identifier (NPI) number when they submit Medicaid or Medicare claims, as well as when they apply to enroll in the programs, according to a final rule published by the Centers for Medicare & Medicaid Services (CMS) in the Federal Register on April 27. 

The rule will take effect 60 days after its publication.

The 10-digit identification number will be required for use in all HIPAA-eligible transactions to help curb fraud and abuse in the government healthcare payment programs.

CMS said the final rule will ensure that only qualified, identifiable healthcare providers and suppliers are ordering or certifying medical services, equipment and supplies for Medicare and Medicaid beneficiaries. The rule also will help ensure that beneficiaries receive quality care because CMS will verify the credentials of physicians ordering or certifying supplies, the agency said.

The final rule differs from the interim rule in several ways including:

  • The agency will deny—not just reject—claims that do not include an NPI;
  • Medical residents practicing in states where they are allowed to be licensed will be able to use an NPI to enroll in Medicare; and
  • In states where medical residents are not allowed to be licensed, the teaching physician will need to provide an NPI.

Read the entire rule here.