Ed Zuckerman, PhD
Three Wishes Press
www.ThreeWishesPress.com
June 14, 2006
Do you need an NPI?
You, whom Managed Care changed from a therapist into a generic “provider,” and the HIPAA law turned into the even more anonymous “CE” (Covered Entity), can now become a simple ten-digit number. You will need this National Provider Identifier (NPI) in order to be paid by health insurance and perhaps for other purposes later. Don’t panic; you have until May 22, 2007 to do it, there is no cost, and the numbers last for your lifetime. If you are not now and don’t want to be a CE, ignore all this. If you want one for some purpose but are not a CE, you can get one without it making you a CE. Employers who are CEs can use their EINs (since July 30, 2004) but health care organizations will need to get NPIs as well as will the individuals involved in health care. Once you get your NPI you must furnish updates to its data within thirty days of any changes. Got all that?
Application for an NPIs can be made on paper and via the internet. It takes 15-30 minutes. The website is <https://nppes.cms.hhs.gov> and the phone is 1-800-465-3203. Mike Feely, the savvy therapist, and aficionado of bureaucracy suggested VNPIs (Vanity National Provider Identifiers) for a small fee which could go to the National Coalition to fight HIPAA. Can someone look into this, please?
Step-by-step guidance to applying for an NPI online
In this guide each numbered paragraph indicates a different “page” on the website and each number with a letter indicates a section of that website page.
1. Go to the National Plan & Provider Enumeration System (NPPES) site at <https://nppes.cms.hhs.gov>. The “s” at the end of the “http” indicates that the site is encrypted for security. If you become puzzled, each of the succeeding pages has access to “Help,” in the upper right corner of the screen, which offers some clarifications.
2. Then, “If you are a Health Care Provider, the ...“. Click on the blue words “National Provider Identifier (NPI)” in that sentence. This link is not underlined nor in a different typeface so violates even the federal rules for accessible site design. This is galling as three of the four sponsors are federal organizations and the fourth is paid by them. A most generous psychologist, Ken Pope, has the best information on accessibility at <www.kpope.com> if you want to make you site accessilble or assist or inform others.
3. On the next page, decide if you “Need an NPI?” and then click on “Apply online for an NPI,” (just in blue), or whether you “Want to View or Update your NPI data?” Again just blue and odd capitalization. If you should decide that you want to change anything you have entered after you complete the application you will not be able to do so until your application is completed (not “Pending”) so don’t bother returning to the site until that time (There is no information on the site as to when that might be or how you will know.)
4. The next page offers an incomplete list of the information you will need to have to apply for an NPI. Use the boldfaced information in the procedures below instead. Click on the long button at the bottom to move on.
5. For secure access to your NPI information for making changes you must create all of these:
a. NPI User ID - not case sensitive.
b. NPI Password - requires at least 6 and up to 12 letters and numbers and it is case sensitive so use all lowercase or all upper or whatever is your personal approach to these things.
c. Secret question - selected from the list of nine. I find many on this list to be too variable to remember (e.g. “Who taught the class you remember most from school,” “What is your favorite food?“) and so think that only two of these are likely to be used by the majority of persons applying. Bad design.
d. Answer - type it in
and click on the ”Next>” button.
6. On the next page select an Entity type: “Type 1: An individual ... or “Type 2: an organization ╔” and click “Next >.” From here on I am going to assume that you are an individual, your Entitiyness.
7. This page asks for a lot of information.
7a Name: First, Middle (not required), and Last
7b. Credential (usually your last Degree earned). Format does not matter (i.e. PhD is same as Ph.D.) and this is not required so offer what you like.
7c Other name (“Professional,” “Former.” or “Other.” Not “Maiden.” Thank you for not being a Neanderthal - First, Middle (optional), Last.
7d. Credential - as above but for the Other Name.
Presumably all the following are the same for all of you (you and your other names).
7e. Date of Birth - in mm/dd/yyyy format with slashes. Unusual format.
7f. Social Security Number - as 9 digits without dashes. Unusual format. If you have no SSN then ITIN (Individual Taxpayer Identifier Number).
7g. Country of birth. If USA then select a State of Birth from the drop down list. If not USA, leave State of Birth blank.
7h. Gender (sic) - male or female.
Click the “Next >” button at the bottom.
8a. Mailing address. This is to be a long term way to reach you so it is probably best to use your home address. If you have a foreign or military address a new page will ask for a more detailed address.
a. Up to two lines. You can use a P. O. Box here.
b. City
c. State - from the drop down list. Can’t be typed in.
d. Zip code - asks for nine but accepts five digits and the program fills in the last four later anyway.
e. Phone - this is optional. Enter without dashes or parentheses. Fax - same
9b. Standardized address. The program converts your typing to the Postal Service’s standards and then asks you to: a. Accept this standardized address or b. Keep what you have entered or c. Change what you had typed in and have it “revalidated.” Go with the (standardized) flow if you can.
10a. Practice Location (Address). You can choose only one so select your main or primary practice location. You can select “Same as Mailing Address.” If you do, the program enters that information for you and then you can select “Next>” to save it. The layout does not make this process very clear.
a. Up to two lines. Here you can’t use a P. O. Box
b. City
c. State - from drop down list. Can’t be typed in.
d. Zip code - five digits are enough
e. Phone number - Enter the numbers without dashes or parentheses. For fax do the same.
10b. Standardized address. As above.
11. On the next page you begin the process of adding the following four types of information: Your profession (e.g. Psychologist); license number, and any other healthcare identification numbers such as for Medicare and the state of of your licensure, and your specialty area(s) of practice (you can choose up to 20 of these.). You can delete or add to this list later. Choose either 11a or 11b.
11a. To enter your billing numbers click on “Add Identifier” button. These numbers the main way that your NPI will be identified with all the identifiers given you by insurance companies, and other billers so try to enter all of yours. Do not enter your state license number on this page. Anyway, enter your UPIN, Medicare, and Medicaid numbers and the State you practice in for each. You can enter more by selecting “Other” in the same manner. Supposedly, the fourth box asks for a “Description” only if you have selected “Other” in the first box. I don’t know what to tell you to enter. Click on “Save” to enter more or on “Next>” when done.
11b. If you don’t have these numbers or want to enter them later, click on “Next>.”
12. On this page you select a code number for your “Taxonomy/Provider Type (professional discipline). Select from 18. Most likely will be “10 - Behavioral Health and Social Service Providers.” Note that psychologists amd social workers are treated the same. Also possible is “17 - Other Service Providers.” The “Type” is the first two numbers, not the name. Clicking “Next>” with take you to where you indicate your areas of practice or specialties.
13a. “Taxonomy selection” is what we would call a practice area or specialty. It has nothing to do with paying your taxes. The categories seem to me an odd selection but here they are:
Neuropsychologist
Neuropsychologist - Clinical
Psychologist
Psychologist - Addiction (Substance Use Disorder)
Adult Development & Aging
Behavioral
Clinical
Counseling
Child, Youth & Family
Educational
Exercise & Sports
Family
Forensic
Health
Men & Masculinity
Mental Retardation & Developmental Disabilities
Psychoanalysis
Psychotherapy
Psychotherapy, Group
Rehabilitation
School
Women
As of June 2006 I have heard that APA is complaining about the unreality of these. Stay tuned.
13b. For each one chosen you must enter your license number and the state you are licensed in. I don’t know what to recommend here. Should you enter a lot of specialties (up to 15 are allowed) so that in some future use of the NPI you are not excluded from a practice area? Should you choose many for which you are not well qualified just to be on the safe side? Or should you enter one and, if and when others are needed, you can return and modify your selections?
In states like Pennsylvania where there is no specialty licensure - all are licensed as “Psychologists” - should you offer the same one license number for all specialties you indicate? Or should you select just the generic “Psychologist” from the list above? Anyway, clicking on Save produces a summary page on which you can choose another Provider Type and another Specialty by clicking on “Add Taxonomy.” I chose the simplest path.
14. You must provide some way that NPPES can reach you. You can use your “Provider” information for your Contact person by clicking the first box. Seems the simplest to me. Then you must slip down to the third paragraph and enter a phone number and email address for this person (you, the provider). In the middle of the page you can enter a name (and credentials if you like) for an “Alternate Contact Person.” You will then enter the phone number and email for this alternate person in the third paragraph. I know this is confusing. That is why this process took me, the HIPAA expert, 45 minutes.
15. Next is the Certification page on which you check a box that indicates that:
a. The information you entered is “true, correct, and complete.”
b. You authorize NPI Enumerator to verify your information.
c. You have read the Penalties. Signing that your info is true subjects you to penalties for errors/“falsifying info”.
Clicking on “Next>” brings you to the end of this leg of your professional journey.
16. You get a “Thank you,” a Tracking number, and information on How to reach the Enumerator. You do not get information on what happens next or when that might be. I (EZ) received an email with my number in a few days.
We have now come to the end of our little adventure in bureaucracy. If you would like to be informed of further developments in HIPAA and the NPI, please go to www.TheeeWishesPress.com and click on the box at the bottom of the page. I will not sell your information or spam you.
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Time on site to complete NPI process: 48 minutes.
Time to write this up: 3 hours.
Distribution: Ed’s Tech Col,, reprinted -send to all orgs., post on website, on Mail Lists. To Fox systems and the Enumerator.