NRPM: Standard Health Care Provider Identifier. b. Health plans.


Health plans that engage in electronic commerce would have to modify their systems to use the NPI. This conversion would have a one-time cost impact on Federal, State, and private health plans alike and is likely to be more costly for health plans with complex systems that rely on intelligent provider numbers. Disruption of claims processing and payment delays could result. However, health plans would be able to schedule their implementation of the NPI and other standards in a manner that best fits their needs, as long as they meet the deadlines specified in the legislation.

Once the NPI has been implemented, health plans’ coordination of benefits activities would be greatly simplified because all health plans would use the same health care provider identifier. In addition, utilization review and other payment safeguard activities would be facilitated, since health care providers would not be able to use multiple identifiers and could be easily tracked over time and across geographic areas. Health plans currently assign their own identification numbers to health care providers as part of their enrollment procedures, and this would no longer be necessary. Existing enumeration systems maintained by Federal health programs would be phased out, and savings would result.