How to Fill the National Provider Identifier (NPI) Application/Update Form
The National Provider Identifier (NPI) is a unique identification number assigned to healthcare providers in the United States. It is essential for providers to have an NPI in order to conduct business and receive reimbursements from various insurance plans and government programs. If you are a healthcare provider and need to apply for or update your NPI, here is a step-by-step guide on how to fill the application/update form.
National Provider Identifier
The National Provider Identifier (NPI) is a HIPAA Administrative Simplification Standard. The NPI is a unique identification number for covered healthcare providers. Covered healthcare providers and all health plans and healthcare Clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in all electronic HIPAA standards transactions. However, some LTSS providers are considered “Atypical Providers” because they render non-health or non-medical services to All well members. These providers bill using their Atypical ID (LTSS #) in the Non-NPI Provider ID field of the claim form.
Who Can File Claims?
All providers — whether in-network or out-of-network — who have rendered services to Sunflower members can file claims. It is important that providers ensure that Sunflower has accurate billing information on file. Please confirm with the Customer Service department or your dedicated provider relations specialist that the following information is current in our files:
▪ Provider Name (as noted on current W-9 form)
▪ National Provider Identifier (NPI)
▪ Tax Identification Number (TIN)
▪ Taxonomy Code
▪ Physical Location Address (as noted on current W-9 form)
▪ Billing Name and Address
▪ Current Valid License
Link – https://texashistory.unt.edu/ark:/67531/metapth638895/m2/1/high_res_d/UNT-0023-0002.pdf
Additional advanced features are available for those providers who create an account. All enrolled
providers are eligible for this free account. Once an account is activated, providers will have access to:
Notification of an invalid address on file for any Texas Provider Identifier (TPI) associated with a
provider’s National Provider Identifier (NPI).
Step 1: Access the NPI Application/Update Form
The first step is to access the NPI application/update form. You can do this by visiting the official website of the National Plan and Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov/. On the website, you will find the option to create an account or log in if you already have one.
Step 2: Provide Basic Information
Once you have logged in, you will be directed to the application/update form. The form will require you to provide basic information about yourself or your organization. This may include:
- Legal name
- Business name (if applicable)
- Contact information (address, phone number, email)
- Social Security Number (SSN) or Employer Identification Number (EIN)
- Date of birth (for individual providers)
Make sure to double-check the accuracy of the information before proceeding to the next step.
Step 3: Select Provider Type
In this step, you will need to select the appropriate provider type that best describes your role in the healthcare industry. The options may include:
- Physician
- Dentist
- Nurse Practitioner
- Pharmacist
- Physical Therapist
- And many more
Choose the provider type that aligns with your profession or specialty.
Step 4: Provide Practice Location Information
Next, you will be asked to provide information about your practice location(s). This may include:
- Address
- Phone number
- Fax number
If you have multiple practice locations, you will have the option to add them individually.
Step 5: Select Taxonomy Codes
Taxonomy codes are used to classify healthcare providers into different specialties or areas of practice. In this step, you will need to select the appropriate taxonomy codes that best represent your professional services. The NPPES website provides a comprehensive list of taxonomy codes to choose from.
Step 6: Review and Submit the Form
Before submitting the form, it is crucial to review all the information you have provided to ensure its accuracy. Check for any errors or omissions and make the necessary corrections. Once you are satisfied with the form, you can submit it electronically through the NPPES website.
After submitting the form, you will receive a confirmation email with further instructions on the next steps to complete the NPI application/update process. It may take some time for your application/update to be processed, so be patient and follow any additional instructions provided by the NPPES.
Conclusion
Filling out the National Provider Identifier (NPI) application/update form is a crucial step for healthcare providers in the United States. By following the steps outlined above, you can ensure that you provide all the necessary information accurately and efficiently. Remember to review the form before submitting it and follow any additional instructions provided by the NPPES. Obtaining or updating your NPI is essential for smooth operations and reimbursement in the healthcare industry.
