Neurosurgery Coding Alert

Question: Our practice is moving from Ohio to Pennsylvania. Do our providers need to apply for new NPIs because we are relocating? 

Ohio Subscriber

Answer: Even though you’re moving your office from one state to another, the practitioners’ national provider identifiers (NPIs) will remain status quo.

NPIs were mandated in 2004 under the NPI rule to align with HIPAA and simplify electronic transactions. They consist of a 10-digit numeric identifier and are specifically for HIPAA-covered healthcare providers.

NPIs don’t “carry information about you, such as the State where you practice, your provider type, or your specialization,” Medicare guidance says. And that’s why “your NPI will not change, even if your name, address, taxonomy, or other information changes,” notes the MLN booklet, “NPI: What You Need to Know.”

Remember: “HIPAA standard transactions are exchanges involving the transfer of information between two parties for specific purposes,” reminds the MLN booklet. “HIPAA regulations established ... standard transactions for Electronic Data Interchange (EDI) of healthcare data.”

Here is a list of standard transactions governed by HIPAA, according to Centers for Medicare & Medicaid Services (CMS) guidance:

• Payment and remittance advice
• Claims status
• Eligibility
• Coordination of benefits
• Claims and encounter information
• Enrollment and disenrollment
• Referrals and authorizations
• Premium payment

Tip: Though NPIs remain the same after a move, covered healthcare providers still need to notify the National Plan and Provider Enumeration System (NPPES) of an address change within 30 days of the move, CMS indicates.“We encourage healthcare providers who have been assigned NPIs, but who are not covered entities, to do the same. A healthcare provider may submit the change to NPPES via the internet or by paper,” CMS advises. If using a paper format, providers should use the NPI Application/Update Form (CMS-10114).

Resources: Access the online NPI update form at https://nppes.cms.hhs.gov/?forward=static.npistart#/ or download the paper option at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS013118.