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NPIsandTaxonomyCodes:WhoWhatWhenWhereandWhyBackgroundBeforethepromulgationoftheHIPAAAdministrativeSimplification:StandardUniqueHealthIdentifierforHealthCareProvidersfinalrulein2004,healthcareprovidersoftenhadseveraldifferentbillingidentificationnumberswithinahealthplan,andacrossthehealthcaresystem.
Therewasnostandardizationamonghealthplans,anditoftenledtoconfusionforprovidersandinsurersintheclaimssubmissionprocess.
Inresponse,amulti-stakeholdereffortwasledbyCMStoprovidestandardizationamongthepublicandprivatesectors.
InMarch2005,CMSissuedafinalrulethatobligatedhealthcareproviderstouseauniqueprovideridentifier,knownastheNationalProviderIdentifier(NPI).
WhatisanNPIANationalProviderIdentifierorNPIisaHealthInsurancePortabilityandAccountabilityAct(HIPAA)AdministrativeSimplificationStandard.
Itisaunique,intelligence-freenumericidentifierusedtoidentifyhealthcareprovidersinstandardtransactions,suchclaims,eligibilityinquiriesandresponses,claimstatusinquiriesandresponses,referrals,andremittanceadvices.
WhomustapplyforanNPIAllHIPPA-coveredentities:healthplans,healthcareclearinghouses,andhealthcareproviderswhoelectronicallytransmitanyhealthinformationinconnectionwithtransactionsforwhichHHShasadoptedstandards.
Formoreinformation,pleaseseethisDearProviderletterfromtheCMSAdministrator.
HowdoyouapplyforanNPITherearethreewayshealthcareprovidersmayapplyforanNPI.
Seehere.
ProvidersmustselectataxonomycodewhencompletingtheirapplicationforanNPI.
WhatisataxonomycodeTaxonomycodesareusedbyhealthcareproviderstoself-identifytheirspecialtybasedonwhichtaxonomycodebestmatchestheirspecialty.
TheHealthCareProviderTaxonomycodesetisacollectionofuniquealphanumericcodes,tencharactersinlength.
Thecodesetisstructuredintothreedistinct"levels"includingProviderGrouping,Classification,andAreaofSpecialization.
WhattaxonomycodesareavailableforAddictionMedicineThereareseveralcodesavailableforaddictionmedicine.
Providersshouldselecttheonethatmostcloselyresemblestheirareaofspecialization.
Source:NationalUniformClaimCommitteeStatus–EffectiveDateDescriptionSpecializationNEW–April1,2019AphysicianengagedinthesubspecialtypracticeofAddictionMedicinewhospecializesintheprevention,evaluation,diagnosis,AddictionMedicineNPIsandTaxonomyCodes:WhoWhatWhenWhereandWhytreatment,andrecoveryofpersonswiththediseaseofaddiction.
ACTIVE-2009Ananesthesiologistwhospecializesinthediagnosisandtreatmentofaddictions.
AddictionMedicineACTIVE-2009Afamilymedicinephysicianwhospecializesinthediagnosisandtreatmentofaddictions.
AddictionMedicineACTIVE-2007Aninternistdoctorofosteopathythatspecializesinthetreatmentofaddictiondisorders.
Adoctorofosteopathythatisboardeligible/certifiedbytheAmericanOsteopathicBoardofInternalMedicinecanobtainaCertificateofAddedQualificationsinthefieldofAddictionMedicine.
AddictionMedicineACTIVE-2007Adoctorofosteopathyboardeligible/certifiedinthefieldofPsychiatrybytheAmericanOsteopathicBoardofNeurologyandPsychiatryisabletoobtainaCertificateofAddedQualificationsinthefieldofAddictionMedicine.
AddictionMedicineACTIVE-2007AddictionPsychiatryisasubspecialtyofpsychiatrythatfocusesonevaluationandtreatmentofindividualswithalcohol,drug,orothersubstance-relateddisorders,andofindividualswithdualdiagnosisofsubstance-relatedandotherpsychiatricdisorders.
AddictionPsychiatryWhyisitimportantthatIselectthecorrecttaxonomycodeInadditiontorequiringtheselectionofanappropriatetaxonomycodewhenapplyingforanNPI,manyinsurersrequiretheuseoftaxonomycodestoissuebillingcredentials,processhealthinsuranceclaims,anddeterminenetworkadequacy.
Therefore,itisimportantthatprovidersselectthetaxonomycodethatmostcloselyresemblestheirspecialtytoensurecorrectpaymentofclaims.
Tofindyourtaxonomycode,clickhere.
DoIhavetohavethedefinitionsource'scertificationinordertochoosethecodeNPIsandTaxonomyCodes:WhoWhatWhenWhereandWhyAccordingtotheNUCC,"thesourceofthedefinitionfortheprovidercodeisaspecificprofessionalorganizationorcredentialingBoard.
Youdonotneedtohavethatsource'scertificationtochoosethecode.
Thesourcesforthedefinitionsareonlytocitewhoauthoredthedefinition.
Thedefinitionswerechosenbecausetheywereidentifiedasanoveralldescriptionoftheprovider.
"WherecanIfindoutmoreinformationabouttaxonomycodesNationalUniformClaimCommittee(maintainscodesetandapplicationsfornewcodes):http://www.
nucc.
org/index.
phpCMS:https://www.
cms.
gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll/taxonomy.
html
Therewasnostandardizationamonghealthplans,anditoftenledtoconfusionforprovidersandinsurersintheclaimssubmissionprocess.
Inresponse,amulti-stakeholdereffortwasledbyCMStoprovidestandardizationamongthepublicandprivatesectors.
InMarch2005,CMSissuedafinalrulethatobligatedhealthcareproviderstouseauniqueprovideridentifier,knownastheNationalProviderIdentifier(NPI).
WhatisanNPIANationalProviderIdentifierorNPIisaHealthInsurancePortabilityandAccountabilityAct(HIPAA)AdministrativeSimplificationStandard.
Itisaunique,intelligence-freenumericidentifierusedtoidentifyhealthcareprovidersinstandardtransactions,suchclaims,eligibilityinquiriesandresponses,claimstatusinquiriesandresponses,referrals,andremittanceadvices.
WhomustapplyforanNPIAllHIPPA-coveredentities:healthplans,healthcareclearinghouses,andhealthcareproviderswhoelectronicallytransmitanyhealthinformationinconnectionwithtransactionsforwhichHHShasadoptedstandards.
Formoreinformation,pleaseseethisDearProviderletterfromtheCMSAdministrator.
HowdoyouapplyforanNPITherearethreewayshealthcareprovidersmayapplyforanNPI.
Seehere.
ProvidersmustselectataxonomycodewhencompletingtheirapplicationforanNPI.
WhatisataxonomycodeTaxonomycodesareusedbyhealthcareproviderstoself-identifytheirspecialtybasedonwhichtaxonomycodebestmatchestheirspecialty.
TheHealthCareProviderTaxonomycodesetisacollectionofuniquealphanumericcodes,tencharactersinlength.
Thecodesetisstructuredintothreedistinct"levels"includingProviderGrouping,Classification,andAreaofSpecialization.
WhattaxonomycodesareavailableforAddictionMedicineThereareseveralcodesavailableforaddictionmedicine.
Providersshouldselecttheonethatmostcloselyresemblestheirareaofspecialization.
Source:NationalUniformClaimCommitteeStatus–EffectiveDateDescriptionSpecializationNEW–April1,2019AphysicianengagedinthesubspecialtypracticeofAddictionMedicinewhospecializesintheprevention,evaluation,diagnosis,AddictionMedicineNPIsandTaxonomyCodes:WhoWhatWhenWhereandWhytreatment,andrecoveryofpersonswiththediseaseofaddiction.
ACTIVE-2009Ananesthesiologistwhospecializesinthediagnosisandtreatmentofaddictions.
AddictionMedicineACTIVE-2009Afamilymedicinephysicianwhospecializesinthediagnosisandtreatmentofaddictions.
AddictionMedicineACTIVE-2007Aninternistdoctorofosteopathythatspecializesinthetreatmentofaddictiondisorders.
Adoctorofosteopathythatisboardeligible/certifiedbytheAmericanOsteopathicBoardofInternalMedicinecanobtainaCertificateofAddedQualificationsinthefieldofAddictionMedicine.
AddictionMedicineACTIVE-2007Adoctorofosteopathyboardeligible/certifiedinthefieldofPsychiatrybytheAmericanOsteopathicBoardofNeurologyandPsychiatryisabletoobtainaCertificateofAddedQualificationsinthefieldofAddictionMedicine.
AddictionMedicineACTIVE-2007AddictionPsychiatryisasubspecialtyofpsychiatrythatfocusesonevaluationandtreatmentofindividualswithalcohol,drug,orothersubstance-relateddisorders,andofindividualswithdualdiagnosisofsubstance-relatedandotherpsychiatricdisorders.
AddictionPsychiatryWhyisitimportantthatIselectthecorrecttaxonomycodeInadditiontorequiringtheselectionofanappropriatetaxonomycodewhenapplyingforanNPI,manyinsurersrequiretheuseoftaxonomycodestoissuebillingcredentials,processhealthinsuranceclaims,anddeterminenetworkadequacy.
Therefore,itisimportantthatprovidersselectthetaxonomycodethatmostcloselyresemblestheirspecialtytoensurecorrectpaymentofclaims.
Tofindyourtaxonomycode,clickhere.
DoIhavetohavethedefinitionsource'scertificationinordertochoosethecodeNPIsandTaxonomyCodes:WhoWhatWhenWhereandWhyAccordingtotheNUCC,"thesourceofthedefinitionfortheprovidercodeisaspecificprofessionalorganizationorcredentialingBoard.
Youdonotneedtohavethatsource'scertificationtochoosethecode.
Thesourcesforthedefinitionsareonlytocitewhoauthoredthedefinition.
Thedefinitionswerechosenbecausetheywereidentifiedasanoveralldescriptionoftheprovider.
"WherecanIfindoutmoreinformationabouttaxonomycodesNationalUniformClaimCommittee(maintainscodesetandapplicationsfornewcodes):http://www.
nucc.
org/index.
phpCMS:https://www.
cms.
gov/medicare/provider-enrollment-and-certification/medicareprovidersupenroll/taxonomy.
html
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