The National Provider Identifier, or NPI, is a unique 10-digit identification number assigned to individual healthcare providers. Since 2007, health plans, clearinghouses and other providers have used the NPI to standardize administrative and financial transactions, such as billing, to improve electronic transmission efficiency. Once assigned, NPIs are permanent and follow the provider regardless of location or job changes. If you do not currently have an individual NPI, you will need to obtain one even if a billing company prepares the claims or bills for your services.
The Colorado Division of Workers Compensation's Rule 16 states, “National provider identification (NPI) numbers are required for workers‘ compensation bills; providers who cannot obtain NPI numbers are exempt from this requirement. When billing on a CMS-1500, the NPI should be that of the rendering provider and should include the correct place of service codes at the line level.” (Colorado Workers' Compensation, Rule 16-7(D), page 11).
All medical providers billing Pinnacol are required to submit their associated NPI on bills for services. Claim forms received without NPIs will be denied for payment due to missing information.
How to sign up
There is no fee to obtain an NPI. Follow the steps below to easily apply online or by mail.
- Create your new account at https://nppes.cms.hhs.gov/#/ on the NPPES (National Plan & Provider Enumeration System) website.
- Select “Create or Manage an Account” and follow the steps to register as a new user in the Identify & Access Management System.
- Once you have set up your user ID account, you can return to NPPES and log in with your new ID from “Registered User Sign In.”
2. By mail:
- Obtain the necessary form by downloading it from here: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS10114.pdf
- Send the completed application to:
P.O. Box 6059
Fargo, ND 58108-6059
- Staff from the NPI Enumerator office will enter the application data in NPPES and you will be notified of your number by mail.
- If you have questions, contact the NPPES office:
Phone: 1.800.465.3203 or TTY 1.800.692.2326
Who can obtain NPIs
NPIs can be obtained for physicians, pharmacists, physician assistants, midwives, nurse practitioners, nurse anesthetists, dentists, chiropractors, clinical social workers, professional counselors, physical therapists, occupational therapists, pharmacy technicians, athletic trainers, hospitals, home health care agencies, nursing homes, residential treatment centers, laboratories, pharmacies and medical equipment companies.
What you need to apply
- The NPI application will require you to list a business mailing address and the clinic location address. These addresses can be the same if you receive mail at the same location where you practice. Your business mailing address and practice location are public information on the NPI Registry on the NPPES site, and you can update them at any time.
- Anyone you designate as your Contact Person can apply for and/or make changes to your NPI on your behalf.
- Determine your Taxonomy Code, which is an assigned number representing your specialty or type of practice. The list of codes with definitions is available here.
How long it takes to apply and receive your number
- If you have your registration information available, NPPES estimates it takes 10 minutes to complete the online application or 20 minutes to fill out the paper form.
- Turnaround time for obtaining your assigned number is typically one day for electronic submissions.
- With a paper application, it may take up to 60 days. According to NPPES, the average time to receive a number with a mailed application is ten days.
What if I forgot my NPI?
- You can obtain your user ID or password by selecting “Forgot User ID or Password” on the NPPES website. You can reset these by following the screen instructions. You must answer your three security questions or enter the required user information (such as the unique email address) associated with your account.
If you have any questions, Pinnacol’s provider medical billing staff would be happy to assist you. Please call the Medical Payments Team at 303.361.4940 or email email@example.com (Fax: 303.361.5940).