Subpart D—Standard Unique Health Identifier for Health Care Providers

Under such system, the Secretary may impose appropriate fees on such physicians to cover the costs of investigation and recertification activities with respect to the issuance of the identifiers.

(b) Unique Health Identifiers.-- ``(1) In general.--The Secretary shall adopt standards providing for a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the health care system. In carrying out the preceding sentence for each health plan and health care provider, the Secretary shall take into account multiple uses for identifiers and multiple locations and specialty classifications for health care providers. ``(2) Use of identifiers.--The standards adopted under paragraph (1) shall specify the purposes for which a unique health identifier may be used.

It is the purpose of this subtitle to improve the Medicare program under title XVIII of the Social Security Act, the medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system, by encouraging the development of a health information system through the establishment of standards and requirements for the electronic transmission of certain health information.

NPPES health care provider data that are required to be disclosed under the FOIA will be available as a downloadable file on a Web site.

National Provider Identifier Standard (NPI)

NPS DATA ELEMENTS

We agree with commentersthat it would be costly to collect,validate, and maintain certification andschool information.

The NPI may also be used for anyother lawful purpose requiring theunique identification of a health careprovider.

HHS will exercise overallresponsibility for oversight andmanagement of the NPS.

The NPS will be designed to be easyto use. The design will employ the latesttechnological advances whereverfeasible for capturing health careprovider data and making informationavailable to users.

Communicate to the NPS anychanges to its required data elements inthe NPS within 30 days of the change.

A strong majority ofcommenters supported our proposalthat the NPI be intelligence-free.

We find the statedadvantages of a 10-position numericidentifier convincing. We have revisedproposed § 142.402 (now § 162.406(a))to provide that the NPI will be a 10position numeric identifier, with the10th position being an ISO standardcheck digit.

A health care provider’s NPI willnot be deactivated if that health careprovider is sanctioned or barred fromone or more health plans.

We do not consider individuals whoare health care providers (that is, theymeet our definition of ‘‘health careprovider’’ at § 160.103) and who aremembers or employees of anorganization health care provider to be‘‘subparts’’ of those organization healthcare providers, as described earlier inthis section.

We define two categories of healthcare providers for enumerationpurposes. A data element, the ‘‘Entitytype code,’’ in the NPS record for eachhealth care provider will indicate theappropriate category.• NPIs with an ‘‘Entity type code’’ of1 will be issued to health care providerswho are individual human beings.Examples of health care providers withan ‘‘Entity type code’’ of 1 arephysicians, dentists, nurses,chiropractors, pharmacists, and physicaltherapists.• NPIs with an ‘‘Entity type code’’ of2 will be issued to health care providersother than individual human beings,that is, organizations. Examples ofhealth care provider organizations withan ‘‘Entity type code’’ of 2 are: hospitals;home health agencies; clinics; nursinghomes; residential treatment centers;laboratories; ambulance companies;group practices; health maintenanceorganizations; suppliers of durablemedical equipment, supplies related tohealth care, prosthetics, and orthotics;and pharmacies

We decided not toestablish sub-IDs because our decisionsregarding which entities would beeligible to receive NPIs (includingseparate physical locations and subpartsof certain kinds of organization healthcare providers) obviate the need forthem. Sub-IDs may be useful as a laterimplementation feature that wouldsupport EDI routing or other purposes.We will consider an expansion at a latertime to include them, if we determinethat they would be beneficial.

For purposes of this rule, weconsider group health care providers tobe organization health care providers.

that the organization healthcare provider is a legal entity and is thecovered entity under HIPAA if it (or asubpart or component) transmits healthinformation in electronic form

We accommodate this language byrequiring covered health care providersto obtain NPIs for subparts of theirorganizations that would otherwisemeet the tests for being a covered healthcare provider themselves if they wereseparate legal entities, and permittinghealth care providers to obtain NPIs forsubparts that do not meet these tests butotherwise qualify for assignment of anNPI.

Therefore, because these kinds ofentities are not health care providers,they will not be eligible for NPIs.

HIPAA Administrative Simplification:Standard Unique Health Identifier forHealth Care Providers

Guidance on National Provider Identifier (NPI) Enumeration; 45 Code of Federal Regulations(CFR) § 162.412(b)

CMS ANNOUNCES THE STANDARD UNIQUE HEALTH IDENTIFIER FOR HEALTH CARE PROVIDERS FOR USE IN STANDARD TRANSACTIONS UNDER HIPAA