Frequently Asked Questions about the
National Provider Identifier (NPI)
by Laura Groshong, CSWA Government Relations Director (updated on 9/13/08)
1. Who needs a National Provider Identifier?
All clinicians who treat Medicare clients and all clinicians who are required to conform to HIPAA requirements, i.e. clinicians who are covered entities (generally those who transmit client information electronically; for a more complete explanation go to: www.clinicalsocialworkassociation.org and select HIPAA Information).
2. When do I need my NPI?
May 23, 2007 was the deadline for clinicians required to have an NPI to continue as Medicare providers. CMS has indicated that they may begin rejecting claims without an NPI as early as July 1.
3. How can I get an NPI?
You can apply for an NPI at: www.cms.hhs.gov/NationalProvidentStand. For alternative methods of applying go to www.nppes.cms.hhs.gov.
4. What is the taxonomy code for clinical social workers, which is required to get an NPI?
The taxonomy code is 1041C0700X.
5. What has happened with the implementation of the new claims reimbursement form, the CMS-1500?
The Center for Medicare and Medicaid Services (CMS) intended for the new CMS-1500 form (previously known as the HCFA 1500) to be required for reimbursement processing by April 1, 2007. The only accepted CMS-1500 is the one which has "08/05" as the date on the form. If Medicare is the primary insurer, you no longer put your name and address in boxes 4 and 7; instead leave these blank. Continue to put NONE in box 11.
You should also no longer list your NPI in box 32a; list your NPI only in box 33a and 24j. Medicare will not accept a whited-out or crossed off NPI in box 32a - it must be blank. If you use a pre-printed CMS-1500, the claim may be denied if any of the above is printed or not printed as required above. LCSWs are encouraged to talk with their Medicare intermediary if they experience problems.
6. Where do I add my NPI on CMS-1500 forms?
CMS-1500 (08/05) forms require the NPI in sections 24j and 33a. For more information on how to fill out the CMS-1500 forms, go to:
http://www.medical-coding.net/claimforms/claim_form_manual_v1-3_7-06.pdf .
7. Can I continue to use my legacy number if I so choose?
No, the NPI is now required for all Medicare claims. Any claim with a legacy number anywhere on the CMS-1500 will be rejected.
8. Where can I get the new CMS-1500 (08/05) forms?
Most stores and websites which sold the HCFA-1500 are now selling the CMS-1500(08/05). There are also several websites which offer electronic versions of the CMS-1500(08/05) for those who file electronically. They can be accessed by a web search of "CMS-1500."
9. Do I need an NPI if I am on insurance company panels?
Almost all insurers now require the NPI as the clinician identifier for reimbursement.
10. Do I need to use an NPI if I am an out-of-network provider?
Almost all insurers now require the NPI as the clinician identifier for reimbursement.
More questions? Contact Laura Groshong, CSWA Director of Government Relations, at lwgroshong@clinicalsocialworkassociation.org.
