Thursday, October 1, 2015

What is HIPAA AND NPI - Definition

The Administrative Simplification provisions of HIPAA require that health plans, including private, commercial, Medicaid and Medicare, healthcare clearinghouses and healthcare providers use standard electronic health transactions. A major intent of the law is to allow providers to meet the data needs of every insurer electronically with one billing format using health care industry standard sets of data and codes. HCPCS is the specified code set for procedures and services. Additional information on HIPAA can be obtained from the CMS website at:


NPI is a HIPAA mandate requiring a standard unique identifier for health care providers. Providers must use this unique 10-digit identifier on all electronic transactions. When billing on paper, this unique number and the provider’s 9-digit Medicaid provider number will be required in order to be reimbursed appropriately. Details about placement of the NPI and the Medicaid provider number are contained within the block-to-block information beginning on page 10. Additional information on NPI can be obtained from the CMS website at:

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