NRPM: Standard Health Care Provider Identifier. C. Approved Uses of the NPI

05/07/1998

The law requires that we specify the appropriate uses of the NPI.

Two years after adoption of this standard (3 years for small health plans) the NPI must be used in the health care system in connection with the health-related financial and administrative transactions identified in section 1173(a). The NPI may also be used as a cross reference in health care provider fraud and abuse files and other program integrity files (for example, the HHS Office of the Inspector General sanction file). The NPI may be used to identify health care providers for debt collection under the provisions of the Debt Collection Information Act of 1996 and the Balanced Budget Act of 1997, and for any other lawful activity requiring individual identification of health care providers. It may not be used in any activity otherwise prohibited by law.

Other examples of approved uses would include:

  • Health care providers may use their own NPIs to identify themselves in health care transactions or related correspondence. · Health care providers may use other health care providers’ NPIs as necessary to complete health care transactions and on related correspondence.
  • Health care providers may use their own NPIs on prescriptions (however, the NPI could not replace the DEA number or State license number where either of those numbers is required on prescriptions).
  • Health plans may use NPIs in their internal provider files to process transactions and may use them on transactions and in communications with health care providers.
  • Health plans may communicate NPIs to other health plans for coordination of benefits.
  • Health care clearinghouses may use NPIs in their internal files to create and process standard transactions and in communications with health care providers and health plans.
  • NPIs may be used to identify treating health care providers in patient medical records.