Confusion surrounds new national doctor ID number

The government and private payers still have to iron out a lot of details before the number will be more boon than burden.

By Joel B. Finkelstein, AMNews staff. Dec. 13, 2004.

Washington -- Physicians will someday be able to use one identification number to fill out all their claim forms, but there is a long road before that goal comes to fruition.

Starting May 23, 2005, physicians can submit an application to the Centers for Medicare & Medicaid Services to receive their own National Provider Identifier. That single ID number will eventually replace all other identifiers that physicians use in reimbursement and other transactions with private payers, clearinghouses and the government.

The 10-digit NPI was established under the Administrative Simplification Compliance Act and is essentially the next phase in the government's effort to move the medical community toward a national standard for electronic transactions as part of the Health Insurance Portability and Accountability Act.

While the May deadline is fast approaching, it will take another two years from that date before health plans are required to start using the NPIs. Still, there is some concern that even two years is not long enough.

"Our biggest fear is that the providers who need the NPI will not get it in time," said Richard Landen, director of electronic standards for the BlueCross BlueShield Assn.

Physicians without an NPI at the end of that two-year period could face delayed or rejected claims.

While CMS and other organizations will be working hard to get that message out to all physicians, experience with previous HIPAA standards suggests that this could prove a difficult task. Outreach has fallen short in the past, leaving many physicians out of the loop.