HIPAA NATIONAL PROVIDER IDENTIFIER (NPI) STATEMENT

We are dedicated to assisting our client’s transition to the utilization of the National Provider Identifier (NPI) as mandated by the Health Insurance Portability and Accountability Act. As of the May 23, 2007 compliance effective date, the NPI will function by substituting all other provider plan IDs and must be used on HIPAA-mandated standard transactions. HealthSmart strictly adheres with the HIPAA guidelines and will continue to work diligently to ensure the highest quality claims processing. We are currently accepting the NPI on professional and institutional claims in accordance with the HIPAA implementation guides published by the Washington Publishing Company and will proceed with comprehensive efforts to communicate valuable information to our clients.

NPI Technical Statement

HealthSmart will be including the NPI in the following segments:

Professional Claims:

  • 2010 AA – If code the qualifier XX and the NPI are included in NM108 and NM109, then either the employer’s identification number or the social security number of the provider must be carried in the 2010AA REF segment.
  • 2010 AB – If code the qualifier XX and the NPI are included in NM108 and NM109, then either the employer’s identification number or the social security number of the provider must be carried in the 2010AB REF segment.

Institutional Claims:

  • 2010 AA – If code the qualifier XX and the NPI are included in NM108 and NM109, then either the employer’s identification number or the social security number of the provider must be carried in the 2010AA REF segment.
  • 2010 AB – If code the qualifier XX and the NPI are included in NM108 and NM109, then either the employer’s identification number or the social security number of the provider must be carried in the 2010AB REF segment.

There is no requirement for the employer’s identification number or the social security number of the provider to be carried on the rendering provider for professional claims or the attending physician on institutional claims if the NPI is provided.