National Provider Identifier

• What is the National Provider Identifier?
• What will the NPI do?
• What does the NPI not do?
• How did CIGNA collect NPIs?
• How did CIGNA test NPIs?
• What was the CIGNA's NPI Contingency plan?
• How should the NPI be included on HIPAA transactions?
• How and when will I receive NPI on HIPAA transactions?
• Will CIGNA reject standard electronic HIPAA transactions without a NPI?
• Am I required to submit my NPI on paper transactions?
• Can I submit claims that include both the NPI and a legacy identifier?
• Will CIGNA require an additional number to designate a provider's location, in addition to the NPI? For example, if a provider works at several sites, should a site-specific number for each location be added to the claim submission?
• Does CIGNA require taxonomy codes to adjudicate submitted claims?
• Will CIGNA disseminate NPI information?
• Where can I find additional NPI information?

What is the National Provider Identifier?

The National Provider Identifier (NPI) is a unique identification number for use in standard health care transactions. The NPI is a new number that is issued to health care providers and covered entities that transmit standard HIPAA electronic transactions (e.g. electronic claims and claim status inquiries). As of May 2005, the Centers for Medicare and Medicaid Services (CMS) began issuing NPIs to providers that apply and qualify.

The NPI fulfills a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and was required to be used by health plans and health care clearinghouses in HIPAA standard electronic transactions by May 23, 2007. The NPI contingency period allowed health care providers and covered entities until May 23, 2008 to become fully compliant with the NPI rule.

CIGNA's NPI Contingency Plan expired on May 23, 2008. CIGNA NPI Guidelines are available for additional NPI information

The NPI fulfills a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and was required to be used by health plans and health care clearinghouses in HIPAA standard electronic transactions by May 23, 2007. The NPI contingency period allowed health care providers and covered entities until May 23, 2008 to become fully compliant with the NPI rule. In addition, the NPI will:

• Replace other provider identifiers previously used by health care providers, and assigned by payers (i.e., UPIN, Medicare/Medicaid Numbers);
• Establish a national standard and unique identifier for all health care providers; and
• Simplify health care system administration and encourage the electronic transmission of health care information.

The NPI does not replace the tax identification number (TIN) on the HIPAA 837 electronic claim and is used for tax reporting. The NPI also does not replace the provider's social security number where it is required in other business processes and/or electronic feeds not covered by HIPAA (i.e., credentialing).

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To reduce the administrative burden on providers, CIGNA has collected all NPIs from the CMS National Plan and Provider Enumeration System (NPPES) database and not from individual providers or facilities. The NPPES health care provider data required to be disclosed under the Freedom of Information Act (FOIA) was made publicly available in September 2007.

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CIGNA tested NPI transactions with EDI vendors and clearinghouses. CIGNA did not test NPI submissions directly with providers. Providers should continue to contact their clearinghouse vendor for more information about including the NPI on their transactions to ensure accurate submissions and reporting.

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CIGNA's NPI Contingency Plan expired on May 23, 2008; CIGNA NPI Guidelines are now available.

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CIGNA is capable of accepting the NPI on standard HIPAA transactions as outlined below. The CIGNA NPI Guidelines document contains information on including NPI on HIPAA transactions. CIGNA will also continue to accept HIPAA transactions without the NPI indefinitely. This approach is supported by guidance received directly from CMS, and should not be confused with any guidance specific to Medicare claims requirements. We will notify you when CIGNA will no longer accept HIPAA transactions without the NPI.

• Required data elements such as the Billing Provider Tax Identification Number (TIN), Rendering Provider name and Rendering Provider address must always be included on Professional, Institutional, and Dental claims. Inclusion of this information should not change as a result of NPI implementation.
• As with any change to a provider's billing process, if a provider plans to change the way claims are submitted to CIGNA as a result of its NPI implementation, the provider must contact the CIGNA Customer Service Center to communicate this change. One example would be a provider that has enumerated multiple NPI sub-parts for an organization, and will start to bill using the "new" sub-part providers.
• When using the NPI to identify the Billing Provider, the TIN must be submitted as the secondary provider identifier. This TIN is the number used on the 1099, which is either the Employer Identification Number (EIN) for organizations or the Social Security Number (SSN) for individuals. Both numbers should not be included. Other identifiers, such as Medicare Provider Number, are considered 'legacy' identifiers as of 5/23/2007 and should not be included.
• Submission of the Billing Provider TIN on the electronic claim is a HIPAA requirement. The National EDI Transaction Set Implementation Guide specifically states the following:
  • "If 'code XX - NPI' is used, then either the Employer's Identification Number or the Social Security Number of the provider must be carried in the REF in this loop. The number sent is the one which is used on the 1099."
• All 837 Professional, Institutional, and Dental claims will be accepted with or without the NPI. The NPI submitted for the Billing Provider will be reflected in the 835 electronic remittance advice.

• All real-time request transactions will be accepted with NPI or legacy identifier. Contact your EDI clearinghouse for details regarding the submission of NPI on these transactions.

CIGNA is capable of accepting the NPI on standard HIPAA transactions as outlined below. The CIGNA NPI Guidelines document contains information on including NPI on HIPAA transactions. CIGNA will also continue to accept HIPAA transactions without the NPI indefinitely. This approach is supported by guidance received directly from CMS, and should not be confused with any guidance specific to Medicare claims requirements. We will notify you when CIGNA will no longer accept HIPAA transactions without the NPI.

• In most instances, the Billing Provider (Claim Payee) NPI will be included on the 835 ERA if the Billing Provider NPI was submitted on at least one 837 electronic claim included in the 835 ERA. If more than one claim included in a single 835 ERA was submitted with NPI, the NPI will be included in the 835 ERA only if all NPI's are equal.
• In most instances, the NPI for Rendering Providers will be included in the 835 ERA, if the Rendering Provider's NPI was submitted on the 837 electronic claim.

• NPI will be returned on real-time response transactions when the NPI is submitted on the corresponding request transaction.

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At this time, the NPI only applies to electronic transactions, and is not required on paper transactions.

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An additional site-specific number is not required. The provider's NPI adoption does not change any current data elements on claims submitted to CIGNA (i.e., TIN, billing name, billing address).

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Taxonomy codes are not required on claims submitted by participating providers. Non-participating providers should include taxonomy codes on submitted claims.

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CIGNA can share NPI information with an individual provider or provider organization. Providers will be required to validate their TIN in order to receive this information. CIGNA will not disseminate the NPI of other health care providers. The NPPES Data Dissemination Notice states: "Entities wishing to obtain the NPI of a health care provider for use in a standard transaction may contact that health care provider directly and request the NPI. Health care providers who are covered entities under HIPAA (known as "covered health care providers") are required by the NPI final rule to disclose their NPIs to any entity that needs them for use in standard transactions."

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For additional information on NPI, use the CIGNA NPI Guidelines, or visit the CMS website at http://www.cms.hhs.gov/hipaa/hipaa2/regulations/identifiers/default.asp. Additionally, The NPPES database can be accessed at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

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