Applying for a National Provider Identifier

The Health Insurance Portability and Accountability Act (HIPAA) requires that as of May 23, 2007, all health-care professionals--including licensed psychologists--use a National Provider Identifier (NPI) when they bill any government or private health insurer electronically. In addition, any private health insurer can require that health professionals who bill the insurer use an NPI, even if the billing is done by mail. So the APA Practice Organization recommends that all psychologists who bill insurers acquire an NPI.

What it is and who needs it

An NPI is a unique 10-digit number assigned to every health-care provider or entity--such as a practice, hospital or clinic--by the Centers for Medicare and Medicaid Services (CMS) for billing purposes. A provider is assigned an NPI for the duration of his or her career, even if he or she relocates, changes employers or even health professions. Unlike past identifying numbers, the NPI is a randomly generated number and does not reveal any information about the provider such as location or practice type.

All "covered entities" under the Health Insurance Portability and Accountability Act (see the HIPAA section at APApractice.org for more information on what constitutes a covered entity) must obtain an NPI. For NPI purposes, sole proprietorships are considered individuals, so solo practitioners should apply as individuals, using their social security number and not their employer identification number.

How to get an NPI

To secure an NPI, practitioners will need to list a taxonomy code--a 10-digit alphanumeric identifier that describes their health-care practice and professional services provided. CMS says that taxonomy codes will help distinguish different health professionals such as multiple providers with the same name. A list of codes is online at www.wpc-edi.com/taxonomy. "Psychologist" and "neuropsychologist" are listed under "Behavioral Health and Social Service Providers." Providers can also choose additional codes under the 19 specialty psychology codes. Due to concerns that the specialty codes could be used to limit a psychologist's scope of practice and/or reimbursement, the Practice Organization generally recommends the simplest approach: choosing the general "psychologist" code (103T00000X) rather than the specialty codes. The Practice Organization is working with the entity that maintains the taxonomy codes to have the specialty codes removed, although this change is unlikely to occur before the practitioners' deadline to obtain the NPI.

One exception to that general advice applies to qualified neuropsychologists whose practice consists entirely of providing neuropsychological services and who might wish to choose the "neuropsychologist" code (103G00000X). The definition of "neuropsychologist," as provided by the National Uniform Claim Committee in the taxonomy code list is "an individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology, a specialty within the field of psychology focusing primarily on neurobehavioral functioning." Neuro-psychologists who also provide services such as psychotherapy, feedback and cognitive rehabilitation may want to designate both the "psychologist" and "neuropsychologist" taxonomy codes. The NPI application can be completed online at https://nppes.cms.hhs.gov. Paper copies of the application can be downloaded from www.cms.hhs.gov/cmsforms. In some cases, employers will complete an NPI on a practitioner's behalf, but only with the practitioner's permission. Practitioners who are employed by a covered entity should check with their human resources or billing department.

To complete the NPI application, psychologists must provide:

• Name.

• Date of birth.

• Country of birth.

• State of birth--if birth was in the United States.

• Gender.

• Social security number or other proof of identity.

• Mailing address.

• Practice location and telephone number.

• State license information--required for certain taxonomies only.

• Business contact name

• Contact phone number and e-mail.

CMS recommends electronic filing as the fastest way to obtain an NPI.