TennCare
Darin Gordon, Deputy Commissioner

National Provider Identification

Print the National Provider Identification (NPI) Form indvidual (pdf, 43kb) or group (pdf, 44kb), complete the form with current information and send it via one of the following means: address or fax.

What is NPI?

The NPI is one of the required HIPAA identifiers to be used in "standard" electronic health care transactions
- unique and permanent healthcare provider identifier
- 10 numeric positions; the 10th digit as a check sum Required in most
X12 transactions and NCPDP Pharmacy transactions
Inactivated only upon death or dissolution of the health care provider
Replaces existing legacy provider numbers used for billing, servicing, referring, etc. including:
- UPIN
- Medicaid Provider Number
- Medicare Provider Number
- Blue Cross and Blue Shield Numbers
- Other internal proprietary health plan provider numbers

What is it for?

Current federal legislation requires that the National Provider Identifier (NPI) be utilized in all HIPAA "standard" EDI transactions beginning May 23, 2007, e.g., X12 837 claims transactions will need to carry NPI in order for providers to be paid
Required whenever the HIPAA Implementation Guides require a provider identifier in a standard transaction
Legacy identifiers cannot be used after May 23, 2007
Reference: 45 CFR Part 162 - HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule
TennCare policy will require the use of NPI on all paper transactions (UB-04, CMS 1500, Dental) and will follow the proposed Medicare implementation timeline.

Who needs an NPI?

Health Care Providers
- Individuals only have ONE NPI
- Organizational options are:
One NPI for all
One NPI per location
One NPI per taxonomy per location
One NPI per taxonomy across locations
Other combinations up to the provider

How is an NPI obtained?

National Plan and Provider Enumeration System (NPPES)
- Uniquely identifies providers
- Validates some data to prevent duplicates
- Assigns NPI

What do TennCare health care providers need to do?

Obtain your NPI NOW.
All new TennCare enrollments effective January 2, 2007, will be required to have their NPI.
If you are currently enrolled in one or more of the following TennCare managed care health plans, submit your NPI information directly to the health plan(s) per procedures established by those organizations. TennCare will obtain your NPI information from them.
- Better Health Plan Inc. (Unison)
- Doral Dental
- First Health
- Heritage National Health Plan of TN (UnitedHealthcare Community Plan - East)
- Memphis Managed Care Corp. (TLC)
- UAHC (Omnicare Health Plan)
- Preferred Health Partnership
- Premier Behavioral Sys of TN
- TennCare Select
- Tennessee Behavioral Health Inc.
- Windsor Health Plan of TN, Inc.
- Volunteer State Health Plan (BlueCare)
TennCare will begin collecting NPIs from health care providers who are not enrolled in one or more of the TennCare managed care health plans on January 2, 2007.