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National Provider Identifier — FAQ


What is NPI? How does it affect me?

Since HIPAA requires the adoption and use of a standard unique identifier for health care providers, the Centers for Medicare and Medicaid Services (CMS) accepted the National Provider Identifier or NPI as the standard identifier for health care providers.


The NPI is a 10-digit unique identifier that will represent health care providers in HIPAA standard transactions. The NPI must be used with HIPAA standard transactions when a provider identifier is required. It will replace health care provider identifiers in use today (including Medicare legacy IDs, UPIN, OSCAR, PIN and National Supplier Clearinghouse numbers).


The NPI itself does not represent demographic data about the provider. All of your demographic data will still be associated with your BCBSM provider identifier(s). It is important for you to continue to follow your current process of contacting BCBSM when updates to your demographic data need to be applied to your BCBSM provider identifier(s).




How many NPIs do I need?

BCBSM recommends obtaining one NPI (in accordance with federal guidelines) for each BCBSM provider identification number you use when submitting claims. Federal guidelines also allow for an NPI to be obtained for unique combinations of tax ID, location and taxonomy (specialty) codes.


By choosing the same identification structure for your NPI numbers as your BCBSM provider identification numbers, you will significantly reduce the degree of change required to adopt NPI and allow us to process your claims without manual intervention, which could cause potential delays.


If you are not aligning your NPI numbers with your BCBSM provider identification numbers, be sure to contact your provider consultant so we can work collaboratively to resolve any resulting issues.





Should I include legacy identifiers on my NPI application?

On the National Provider Identifier application, there is a space for you to list legacy numbers along with the state and name of the company issuing the number.


Recommendation for BCBSM and BCN:

  • When applying for your National Provider Identifier, please include your legacy identifiers, e.g., BCBSM group PIN, facility PIN or individual PIN, not only for Medicare but for all payors.
  • If reporting a Medicaid number, include the associated state name.

This information is critical for payors in the development of crosswalks to aid in the transition to the National Provider Identifier.





Where can I go for more information about the NPI application process?

For more information, visit www.nppes.cms.hhs.gov.




How do I register my NPI(s) with BCBSM?

There are several ways to send us your NPI. Find out how.




As an electronic submitter, how do I register my NPI with the BCBSM EDI clearinghouse?

  1. Download step-by-step instructions for the provider authorization form (PDF)
  2. Go to the Trading Partner login page




What are the NPI reporting instructions for incorporated individuals?

An incorporated individual is an individual health care provider who has formed a legal entity, such as a corporation or limited liability company, under which he or she conducts business, but which has no other health care providers as part of it. The corporation has an employer identification number, also known as a federal tax identification number, used to identify a business entity.


When billing BCBSM for services, incorporated individuals have previously used one BCBSM provider identification number on claims. In response to the federal government's implementation of NPI, incorporated individuals must obtain two NPIs: a Type 1 (individual) NPI associated with their Social Security number and a Type 2 (organizational) NPI associated with their EIN.


Your Type 1 NPI represents you as an individual and your Type 2 NPI represents your business entity. BCBSM will restructure your enrollment records by establishing a new group record to align with your business Type 2 NPI. Your Type 1 NPI will be aligned with your individual PIN record.


If you are submitting or would like to submit claims electronically, please ensure that you have registered your Type 2 NPI with the Electronic Data Interchange Department. You do not need to register your new group PIN, only your Type 2 NPI.


Other important points to assess in relation to your new group PIN are listed below.


  • Access to Web-DENIS — If you have access to Web-DENIS, or wish to establish access to Web-DENIS, you will need to register your new group PIN by filling out the Authorization for Additional Provider Codes application indicating the user IDs that need access to claims for the new group PIN. The completed form should be faxed to 248-486-2214. This will allow you to view claims in Web-DENIS.
  • Billing — Since your Type 2 NPI is now mapped to a group practice PIN, you will need to submit claims by reporting both a billing NPI (Type 2 NPI) and a rendering NPI (your Type 1 NPI). Please do not report your group PIN or individual license number on your professional electronic claims. We recommend that you submit your electronic claims with NPIs only.
  • EFT — If you are not currently enrolled with EFT, we would like to remind you that as of October 1, 2009, all participating professional providers are required to enroll in EFT. This means you will be receiving your payments and vouchers electronically. Please reference the July 2009 issue of The Record for more information.



What are the NPI reporting instructions for providers with multiple locations?

Historically, provider IDs were established to identify specific office locations at the request of the provider. This allows providers to manage the administration of their business separately for each office location.


BCBSM can only recognize these locations if each has an additional NPI associated with it. Consequently, effective May 23, 2008, BCBSM will not have the ability to pay claims for locations that are not enumerated with a separate NPI. BCBSM will need to terminate the BCBSM provider IDs for office locations that were not enumerated with a separate NPI. To do this, you will need to complete the Group Enrollment and Change Form and fax it to Provider Enrollment and Data Management at 866-900-0250.


The individual providers who were affiliated with a terminated group PIN will need to be reassigned to one of the remaining group PINs for office locations that are identified by a unique NPI.


Adding members to a participating group will also require the completion of the Group Practice Agency Authorization form. If you have questions on how to complete these forms, please call Provider Enrollment and Data Management at 800-822-2761.





What are the NPI reporting instructions for hospital psychiatric and rehabilitation units?

Many hospitals are enumerating their Medicare-exempt psychiatric and rehabilitation units separately from the hospital. Currently, BCBSM pays for psychiatric and rehabilitation services under the hospital's facility code. If hospitals have obtained separate NPIs for these units, they must register those NPIs with our Provider Contracting department and with EDI.


BCBSM will associate the NPIs for the hospital rehabilitation and psychiatric units with the existing BCBSM facility code of the hospital. Psychiatric and rehabilitation units in a hospital are not separately contracted with BCBSM. As a result, the hospital NPI will be returned on checks, vouchers and 835 electronic transactions for psychiatric and rehabilitation claims.


If hospitals haven't reported their psychiatric and rehabilitation NPIs to BCBSM, please register with us. If you have questions about how to register your NPIs with BCBSM's Provider Contracting department, please call 800-777-2118.


You are also required to update your Trading Partner Agreement for the EDI Clearinghouse. If you have questions on how to update your TPA, please call EDI at 800-542-0945.





I was notified by BCBSM that I am required to submit taxonomy codes on electronic claims. What taxonomy codes do I need to include on my electronic claims?

Taxonomy codes are used to classify health care providers according to their provider type or specialty. BCBSM is using taxonomy codes to assist in the identification of a provider when they are using one NPI to replace several BCBSM Provider IDs. Electronic claims received for services you normally submit under multiple BCBSM Provider IDs in use today, must contain a taxonomy code, in addition to your NPI, to avoid possible payment delays. This requirement is effective May 1, 2008.


Please view the specific Taxonomy Code Mapping Document to identify the taxonomy code that applies to your provider type and specialty or facility type.


If you have questions regarding the requirement to submit taxonomy codes on electronic claims, please contact your provider consultant.


Instructions for billing electronically using taxonomy codes are found in the BCBSM 837 implementation guides and EDI companion documents. For questions about electronic claims submission, call the EDI help desk at 800-542-0945.


Note: The reporting of taxonomy codes is currently not an option for paper claims submission. If you submit paper claims to BCBSM, you are required to submit them in a dual-use mode, which means reporting both the NPI and BCBSM provider ID on your claims.





What do pharmacies need to know about the NPI contingency plan?

Instructions for pharmacies (PDF)