National Provider Identifier (NPI)
What is an NPI?
A National Provider Identifier, or NPI, is a unique, ten-digit identifier that the Centers for Medicare & Medicaid Services (CMS) issues to all health care providers as mandated by the federal government in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). NPIs eliminate the need for multiple identifiers from different health plans. Any provider covered under HIPAA must obtain one or more NPIs in order to conduct standard transactions.
To ensure successful claims submission, please complete the following steps:
- Get your NPI from CMS.
- Register your NPI with AmeriHealth New Jersey.
- Enable electronic claims submission for your billing provider NPI.
You may also continue reading below for more information on each step.
Get Your NPI
Providers may apply for an NPI from CMS in one of two ways:
- Online. The National Plan and Provider Enumeration System (NPPES), developed by CMS, includes an online application that takes approximately 20 minutes to complete.
- By mail. You can request a paper application by calling the NPI Enumerator call center at 1-800-465-3203.
Once an NPI application has been processed successfully, the applicant will receive a confirmation notice and assigned NPI from CMS. Online applicants will receive confirmation by email, and paper applicants will receive confirmation by standard mail.
Register Your NPI with AmeriHealth New Jersey
All NPIs that identify the billing provider, rendering provider, referring provider, and service facility on claims must be registered with AmeriHealth New Jersey.*
If you would like to be a participating provider, please submit a Provider Participation Form to start the credentialing process. Non-participating providers may register using the appropriate NPI Provider Registration Web Form.
- Professional Providers (e.g., PCPs, specialists)
- Facility/Ancillary Providers (e.g., hospitals, rehabs, DME, ambulance)
Participating providers may also register by mail, using the form that has been included in mailings to participating provider offices.
*Referring providers on claims also must be identified using their CMS-assigned NPI.
Enable Your NPI for Electronic Claims Submission
For electronic claims submission, the NPI that identifies your billing organization must be affiliated with the entity that submits your electronic claims, also known as a trading partner. Please contact your billing software vendor, clearinghouse vendor, or third-party billing service for instructions on how to affiliate your NPI with the appropriate trading partner.
If you are your own trading partner, go to the Trading Partner Business Center to affiliate your NPI to your profile.
For electronic claims submission, please affiliate only the NPI that identifies the billing provider, not individual NPIs for rendering providers.
Use a Valid NPI for All Claims
If claims are submitted with NPIs that do not comply with the above guidelines, they will be rejected automatically.
Common reasons why claims are rejected include:
- One or more NPIs are not registered with AmeriHealth New Jersey
- The billing NPI is not affiliated with the electronic submitter (i.e., trading partner)
- One or more NPI fields on the claim do not contain an NPI
- The NPI is entered incorrectly and does not match the registered NPI
Additional NPI Resources
- View our Frequently Asked Questions about NPI
- Centers for Medicare & Medicaid Services — Information about NPI regulations, implementations, reports, resources, and how to apply. The site also features a frequently asked questions section.
- Taxonomy Codes from the Washington Publishing Company — Providers must supply their taxonomy code when applying for an NPI and when submitting it to AmeriHealth New Jersey.
- Federal Register, January 23, 2004 — HIPAA Administrative Simplification; Standard Unique Health Identifier for Health Care Providers; Final Rule.