NRPM: Standard Health Care Provider Identifier. § 142.408(a),(c) Requirements: Health care providers.


In summary, each health care provider would be required to obtain, by application if necessary, a national provider identifier and communicate any changes to the data elements in its file in the national provider system to an enumerator of national provider identifiers within 60 days of the change.


We are especially interested in receiving comments on the possible methods of managing the provider enumeration process. Given the multitude of possible methods associated with managing the enumeration process, we are unable to provide an accurate burden estimate at this time. Below is the repeated provider identifier enumeration discussion, from section II., Provisions of Proposed Regulations, E. Requirements, 3. Health care providers, of this preamble.

The process by which health care providers will apply for and obtain NPIs has not yet been established. This proposed rule (in section III., Implementation of the NPI) presents implementation options by which health care providers would apply for and obtain NPIs. We are seeking comments on the options and welcome other options for consideration.

In one of the options we are presenting, we anticipate that the initial enumeration of health care providers that are already enrolled in Medicare, other Federal programs named as health plans, and Medicaid would be done by those health plans. Those health care providers would not have to apply for NPIs but would instead have their NPIs issued automatically. Non-Federal and non-Medicaid providers would need to apply for NPIs to a Federally-directed registry for initial enumeration. The information that would be needed in order to issue an NPI to a health care provider is discussed in this preamble in section IV., Data. Depending on the implementation option selected, Federal and Medicaid health care providers may not need to provide this information because it would already be available to the entities that would be enumerating them. In one of the options, health care providers would be assigned their NPIs in the course of enrolling in the Federal health plan or in Medicaid. Both options may require, to some degree, the development of an application to be used in applying for an NPI.

We would require each health care provider that has an NPI to forward updates to the data in the database to an NPI enumerator within 60 days of the date the change occurs. We are soliciting comments on whether these updates should be applicable to all the data elements proposed to be included in the NPF or only to those data elements that are critical for enumeration. For example, we would like to know whether the addition of a credential should be required to be reported within the 60-day period or whether such updates should be limited to name or address changes or other data elements that are required to enumerate a health care provider.

Given the multitude of possible methods of implementing the enumeration process we are soliciting public comment on each of the following issues, before we submit a copy of this document to the Office of Management and Budget (OMB) for its review of these information collection requirements.