NPI (National Provider Identifier) and taxonomy

The National Provider Identifier (NPI) replaces most other numbers currently used to identify provider organizations and individual practitioners on Health Insurance Portability and Accountability Act (HIPAA) compliant health care transactions.

The standardization made possible by NPI and the HIPAA Health Care Provider Taxonomy Code Set will help payers reimburse providers for the correct service, for the right payment amount, and in a timely manner. We therefore ask all of our providers to bill with both NPIs and taxonomy codes whenever they apply.

There are two ways to obtain a national provider identifier (NPI) — as an individual and as an entity.

Apply individually
Providers can apply for an NPI by completing the Centers for Medicare & Medicaid Services (CMS) online application. Providers may also request a paper application from the NPI Enumerator in the following ways:
By phone: 1-800-465-3203 or TTY 1-800-692-2326
By email: customerservice@npienumerator.com
By mail:
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059

Once a provider receives an NPI, he or she is responsible for updating the associated information which is stored in the National Plan and Provider Enumeration System (NPPES) and for appropriately sharing NPI information for purposes of administering health care.

Apply as an entity
An organization can apply with CMS to become a bulk enumerator in order to request NPIs for affiliated practitioners. A practitioner must give permission to the bulk enumerator to obtain an NPI on his or her behalf and to share the information to administer health care.

The organization is then responsible for maintaining the NPIs of its practitioners and all related information until the relationship with the practitioner ends.

In April 2007, the Centers for Medicare and Medicaid Services (CMS) issued guidance related to the implementation of the National Provider Identifier (NPI). CMS allowed entities to invoke a contingency plan aimed at completing any outstanding preparations to fully comply with the NPI mandate no later than May 23, 2008.

Kaiser Permanente’s contingency plan ended May 23, 2008, and we now require an NPI on all standard electronic HIPAA transactions per the mandate.

Kaiser Permanente as a provider
Kaiser Permanente began sending NPIs on all appropriate transactions as of May 2008. Kaiser Permanente will also submit NPI and taxonomy codes into appropriate transactions when and where required by the implementation guides for those transactions.

Kaiser Permanente as a payer
For claims:

• For 837i or 837p electronic claims, Kaiser Permanente will require appropriate NPIs to process the claim. Claims without NPI information will be rejected or denied and the provider should resubmit with the appropriate NPI.
• All CMS 1500 paper claims will require a billing NPI. For Medicare claims, we will also require the same NPI information on paper claims as for electronic.
• All institutional claims, both paper and electronic, will require the HIPAA Health Care Provider Taxonomy Code Set.

Refer to the required fields referenced in CMS 1500 (08/05) Required Fields, UB-04 (CMS-1450) Required Fields, and Claims Payment Reconsideration. For NPI and taxonomy requirements, use our NPI and Taxonomy Requirements grid.

Kaiser Permanente plans to incorporate NPI and the related taxonomy code set into our billing practices to pay your claims as efficiently and accurately as possible.

To improve payment accuracy and timeliness, bill with National Provider Identifier (NPIs) numbers and taxonomy codes wherever and whenever they apply.

All providers
At a minimum, include the following information on both electronic (837i) and paper (UB-04) claims:

• Billing provider NPI, the minimum information needed to process a claim
• Pay-to provider NPI, if different from the billing provider
• Service location NPI, if different from the billing address

Mental health
Mental health providers must include the following taxonomy code information on both electronic (837p) and paper (CMS-1500) claims:

• Billing provider taxonomy code: To indicate the type of service provided by the billing entity. Allows us to pay providers more accurately and to better track these limited benefits for our patients.
• Pay-to provider taxonomy code: Required if different from the billing provider.
• Rendering provider taxonomy code: Required if different from the billing provider.s

Hospitals
In addition to the information applicable to all providers, hospitals are asked to include the following information on both electronic and paper claims:

• Billing provider taxonomy code, a combination of tax ID, NPI, and taxonomy code that replaces the Medicare facility number for hospital payment methodology
• Pay-to provider taxonomy code, if different from the billing provider

Kaiser Permanente's hospital billing requirements are in line with those of Medicare. Like Medicare, we will recognize the following taxonomy codes for hospital units:

• Search NPI registry for providers and facilities

Additional taxonomy codes and information can be found on the Washington Publishing Company website.