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Getting an NPI Number (+Application Checklist)

Getting an NPI Number
 

As an insurance billing company, Holistic Billing has new providers contacting us daily about how to start medical billing. The first step is to apply for NPI (National Provider Identifier) number otherwise known as your NPI number. However, many holistic practices are unaware of how to apply for an NPI. 

Luckily, the application process for getting an NPI number is pretty straightforward. Follow this guide and the NPI application checklist to help your holistic practice obtain its NPI!

What is an NPI?

A National Provider Identifier, or NPI, is a 10-digit identification number issued to healthcare providers in the U.S. by the Centers for Medicare and Medicaid Services. Your NPI will not change, even if your address, taxonomy, or name changes. Although every NPI is unique, it does not carry specific information about you, such as the state where you practice or your specialization.

The NPI must be used in place of other provider identifiers, such as a Provider Transaction Access Number (PTAN), Online Survey Certification & Reporting (OSCAR), and National Supplier Clearinghouse (NSC) when used in HIPAA standard transactions. For reference, HIPAA standard transactions are exchanges involving the transfer of health care data between two parties for specific purposes.

Why Does Your Holistic Practice Need an NPI?

Your holistic practice will need to apply for an NPI if you are a HIPAA-covered health care provider or if you bill insurance for your services. If your practice applies for enrollment, you must have an NPI. Any enrollment application without an NPI will be rejected. 

An NPI also carries other benefits as well, such as simplifying electronic transmission of HIPAA standard transactions and efficient coordination of benefit transactions. However, it’s important to know that applying and receiving an NPI will not ensure you’re Medicare credentialed or replace your current insurance enrollment.  

3 Options to apply for NPI Number

Your holistic practice can get an NPI Number in one of three ways, depending on your preference. 

Option 1: Apply Through a Web NPI Number Application

You can apply for NPI through a web-based application. Visit the National Plan and Provider Enumeration System (NPPES) website. Individual providers must create a username and password through the Identity & Access Management (I&A) System, and log in to NPPES using that username and password. 

Option 2: Apply Through a Mail Paper Application

You can complete, sign, and mail a copy of the application (Form CMS-10114, “NPI Application/Update Form”) to obtain an NPI number to the NPI Enumerator address listed on the form. To request a hard copy application through the NPI Enumerator, call 1-800-465-3203 or TTY 1-800-692-2326, or send an email to customerservice@npienumerator.com. 

Option 3: Apply Through an EFIO

The final option you can apply for an NPI would be to permit an Electronic File Interchange Organization (EFIO) to submit application data through a bulk enumeration process. For more information on this option, check out the CMS website here. 

NPI Application Checklist: How to Fill out the NPI Application

Your holistic practice can use this NPI application checklist to ensure that you have all the correct information when filling out the NPI number application from the CMS. 

NPI application checklist

  • Reason for Submitting NPI Number Application Form
  • Entity Type (Are you an individual or an organization that renders health care?)
  • Identifying Information (including that of sole proprietorships and incorporated individuals) 
  • Organization Name(s)
  • Correspondence Mailing Address Information 
  • Business Practice Location Information
  • Medicaid Identification Number (if applicable)
  • Other (Non-Medicare) Provider Identification Numbers 
  • Provider Taxonomy Code(s)
  • Individual Practitioner’s Signature 
  • Authorized Official’s Signature for the Organization
  • Contact Person’s Information

Common Questions When Applying for an NPI

Besides questions regarding how to apply for NPI, medical practices may still need some clarity on the NPI process. Below are some of the more common questions about applying for an NPI or about the identifier in general.

Will a health care provider’s National Provider Identifier (NPI) ever change?

Your NPI is meant to be a lasting identification number and is expected to remain unchanged even if there are changes made to the information on the original NPI number application. The only situations where your NPI number may change would be when there are certain changes of ownership, purchase conditions, or fraudulent incidents.   

Is the NPI only necessary for Medicare claims only?

The NPI is your identifier for all health insurance plans, both public and private. So, even if your holistic practice does not want to be credentialed with Medicare, you still need to apply for an NPI. 

Do medical students, interns, and residents need NPIs?

All health care providers are eligible for NPIs and may apply for them - regardless if they are students, interns, residents, or fellows. You will not be required to submit an NPI if you do not electrically transmit any data under HIPAA standard transactions. 

I have a solo practice but have incorporated my practice. Do I need both the individual NPI and an NPI for the practice?

In this case, the corporation and the individual therapist should each have an NPI. Your state license number should appear on the individual application. The corporate application should include the number associated with the corporate entity, such as the tax identification number. It is not necessary to include your state license number on the application for the corporate NPI. You must apply for each NPI separately, and you will be asked to create a profile for each type of application on the NPPES Website.

Where can I get more help and information about the NPI?

Visit the CMS Website for more information. The website contains plenty of educational resources for your practice. In addition, you may call the NPPES directly, at 800-465-320.

 Can You Apply for an NPI number without a License?

No, you cannot apply for an NPI number without a license.  In order to be eligible to apply for an NPI number, you must have a valid, active license to practice in your field of healthcare

NPI Services to Simplify the Application Process

Knowing how to apply for an NPI is necessary for most medical practices, including many holistic practitioners, since it’s an integral part of the medical billing process. Since holistic practices operate differently than traditional medical practices, including having unique Medicare requirements, it’s common for holistic health care providers to want more guidance.  If your holistic practice has questions about how to apply for an NPI or anything about the process in general, then NPI services can provide an efficient and simplified application experience. 

Holistic Billing can offer your holistic practice the NPI services you need for a streamlined application process! With years of experience supporting holistic practices, you can trust the experts of Holistic Billing to have the answers you need about the NPI or holistic insurance billing. Contact the team at Holistic Billing today!

 
 
 
 
February 8, 2021
 - by Antonio Arias, MBA, CHBME
getting an npi number
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