The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The purpose of the National Provider Identifier NPI is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers. National physician identifier The NPI National Provider Identifier is the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities.
NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers Rating: 4. An organization health care provider subpart may need to be identified in a standard transaction but the organization health care provider may not be required to obtain an NPI for the subpart. A noncovered health care provider may or may not have applied for and received an NPI. In the latter case, and in the case of the subpart described above, an NPI would not be available for use in the standard transaction. We encourage every health care provider to apply for an NPI, and encourage all health care providers to disclose their NPIs to any entity that needs that health care provider's NPI for use in a standard transaction.
Obtaining NPIs and disclosing them to entities so they can be used by those entities in standard transactions will greatly enhance the efficiency of health care transactions throughout the health care industry. If subparts are assigned NPIs, the covered health care provider must ensure that the subpart's NPI is disclosed, when requested, to any entity that needs to use the subpart's NPI in a standard transaction. Here are examples that illustrate the desirability for a health care provider that is not required to be enumerated to obtain and disclose an NPI:.
Therefore, the pharmacy needs to know the NPI of the prescriber in order to submit the pharmacy claim. The prescriber may be a physician or other practitioner who does not conduct standard transactions. The prescriber is encouraged to obtain an NPI so it can be furnished to the pharmacy for the pharmacy to use on the standard pharmacy claim. The attending physician may be a physician who does not conduct standard transactions. The physician is encouraged to obtain an NPI so it can be furnished to the hospital for the hospital to use on the standard institutional claim.
In the examples above, the NPI of a health care provider that is not a covered entity is needed for inclusion in a standard transaction. The absence of NPIs when required in those claims by the implementation specifications may delay preparation or processing of those claims, or both. Therefore, we strongly encourage health care providers that need to be identified in standard transactions to obtain NPIs and make them available to entities that need to use them in those transactions.
The system would be a comprehensive, uniform system for identifying and uniquely enumerating health care providers at the national level. We did not receive comments specific to our description of the NPS. However, commenters were emphatic that the NPS be fully tested before it began assigning NPIs, and that the system ensure that the same NPI would not be issued to more than one health care provider. Commenters also suggested that an option be made available by which health care providers could apply for NPIs electronically in lieu of completing a paper application form.
This comment is addressed in section II. NPIs will be assigned to health care providers by the NPS, which will be a central electronic enumerating system operating under Federal direction. The NPS may enumerate subparts of organization health care providers. The NPS will be designed to be easy to use. The design will employ the latest technological advances wherever feasible for capturing health care provider data and making information available to users. This is discussed in section II. The NPS will include a database that will store the identifying and administrative information about health care providers that are assigned NPIs.
Identifying and uniquely enumerating health care providers for purposes of the NPI is separate from the process that health plans follow in enrolling health care providers in their health programs. However, the assignment of the NPI will not eliminate the process that health plans follow in receiving and verifying information from health care providers that apply to them for enrollment in their health programs. If a health care provider chooses not to furnish his or her SSN when applying for an NPI, the assignment of an NPI to that health care provider may be delayed and additional information may be requested from that health care provider in order to establish uniqueness.
If the NPS encounters problems in processing the application, appropriate messages will be communicated to the applicant. If problems are not encountered, the NPS will then search its database to determine whether the health care provider already has an NPI. If a health care provider has already been issued an NPI, an appropriate message will be communicated. If not, an NPI will be assigned. If the health care provider is similar but not identical to an already-enumerated health care provider, the situation will be investigated.
We explained that the HIPAA legislation did not contain a specific funding mechanism for activities related to enumeration. We asked for comments on how the enumeration activity and the NPS itself could be funded, and how the costs of enumeration could be kept as low as practicable. We presented two options for the enumeration of health care providers: 1 All health care providers, except existing Medicare providers, would be enumerated by a single entity.
Existing Medicare providers would automatically be enumerated and would not have to apply for NPIs; 2 Federal health plans and Medicaid would enumerate their enrolled health care providers, and a federally-directed registry would enumerate all remaining health care providers. We also presented a phased approach to enumeration and requested public comment on it. In the phased approach, we proposed that enumeration would occur in the following order: 1 Medicare providers; 2 Medicaid, other Federal providers, and health care providers that do not conduct business with Federal health plans or Medicaid but that do conduct electronically any of the transactions specified in HIPAA; and 3 all remaining health care providers.
The May 7, , proposed rule also stated that phase three would not begin until phases one and two were completed. Response: We respond to these issues as follows:. The NPS will run various edits and consistency checks and will check for duplicate records to ensure that only one NPI is assigned to a health care provider and that the same NPI is not assigned to more than one health care provider. Enabling the receipt of Web-based applications and the limited validation will make the cost of enumerating a health care provider far less than enrolling a health care provider in a health plan.
The majority of atypical and nontraditional service providers are not considered health care providers and, therefore, would not be eligible for NPIs. The use of modern technology to receive and process applications for NPIs makes it difficult if not impossible to attach a dollar value to the enumeration of a single provider.
Implicit in enumeration are the costs of software, licenses, salaries, training, and overhead. Comment: The majority of commenters favored enumeration option 1, where a single entity would enumerate all health care providers except existing Medicare providers who would automatically be enumerated. The May 7, , proposed rule recommended enumeration option 2, which would have required Federal health plans and Medicaid to enumerate their enrolled health care providers, with a federally-directed registry enumerating all remaining health care providers.
The supporters of a single enumeration entity cited the following advantages of option 1: 1 It would be less costly than multiple enumeration entities; 2 it would ensure uniform operation of the enumeration process, reducing inconsistencies that could lead to duplicate assignment of NPIs; 3 it would be less confusing to health care providers, particularly those that participate in multiple health plans; 4 it would be a single point of contact with which to do business and seek help and information; and 5 it would ensure uniformity in resolving problems and would be more capable and efficient in responding to data integrity issues that may require investigation.
Comments from Federal health plans and Medicaid State agencies which were the proposed enumeration entities under option 2 stated that they preferred not to have a role as an enumerator. Some Federal health plans anticipated that too many health care providers would request that they handle their updates and changes. Medicaid State agencies indicated that they would require additional Federal funding to assume the responsibilities of enumeration.
Nonetheless, some commenters did support option 2. They stated that having Federal health plans and Medicaid State agencies enumerate their own health care providers had several advantages: 1 These entities already conduct a significant amount of enumeration activity in their health plan enrollment processes, which would bring a wealth of experience to the NPI enumeration process; 2 much of the information required to assign an NPI to a health care provider is already collected by these entities; 3 fraud detection would be enhanced because, as enumeration entities, they would have access to the data in the NPS; and 4 the initial cost of enumerating health care providers would be incremental to these entities, a major factor in making option 2 less costly than option 1.
Response: After analyzing all the comments and reviewing our computations as to the costs of enumeration under both options, we have determined that a single entity, under HHS direction, should handle the enumeration functions. We believe that enumeration by a single entity will be the most efficient option. While supporters of option 2 cited several advantages, the reluctance of the Federal health plans and Medicaid State agencies to undertake enumeration functions was a major factor causing us to support a single entity.
Selection of option 2 would have required those Federal health plans and Medicaid State agencies to perform functions they were not willing to perform. Another factor in our decision to choose option 1 was an oversight in our cost computations. While our narrative discussion of costs indicated that prevalidated Medicare provider files would populate the NPS under both options, Table 5 in the Impact Analysis portion of the May 7, , proposed rule did not reflect those savings in the cost of option 1.
If those savings had been reflected, the cost of option 1 would have been less. Please see the next comment and response regarding Medicare provider files. Costs for option 2 did not include the expenses that would be incurred by Federal health plans and Medicaid State agencies in resolving problems found in their health care provider records that would prevent some of those records from being loaded into the NPS for enumeration of the health care providers. This would have increased the cost of option 2. Had we applied both of these cost factors, both options would cost about the same.
The use of one entity, under HHS direction, to enumerate health care providers will ensure uniform operation of the NPS. Health care providers will have a single contact point for applications, updates, and questions. Problems will be resolved in a uniform manner. These factors make a single enumerator the more efficient option. Comment: Several commenters cautioned against loading pre-existing health care provider files into the NPS. They indicated that any errors present in those files would be carried undetected into the NPS. Commenters cautioned that any data to be loaded into the NPS should be validated, accurate, and up to date.
Response: We agree with the commenters' recommendation that accurate, current data should be included in the NPS. After publication of the May 7, proposed rule, we reexamined the existing Medicare provider files in anticipation of using them to populate the NPS. Our reexamination revealed that some mandatory NPS data elements are not present in some of the Medicare files. In addition, data integrity problems have been identified, and reformatting some of the Medicare files to make them consistent with the structure of the NPS may be more difficult than first expected.
It may require considerable time to update and reformat these files for NPS purposes. It is important to note that we are undertaking steps to update our existing Medicare provider files for independent business reasons. If we find it is feasible to use updated, accurate Medicare provider files to populate the NPS, we will do so, and we will notify the affected Medicare providers that they will not have to apply for NPIs. Comment : Nearly all commenters recommended that the enumeration function and operation of the NPS be federally funded because a Federal statute mandates the adoption and use of a standard unique health identifier for health care providers.
Many commenters stated that the costs cannot be borne directly by health care providers or indirectly by health care provider organizations and clearly stated that health care providers should receive NPIs at no cost. Some stated that if fees need to be assessed, they should come from the health plans, not the Start Printed Page health care providers, as the health plans will receive the most benefit from the use of the standard.
There was some support for the collection of initial fees from health plans, health care clearinghouses, and other nonprovider entities to obtain data from the NPS; the fees would help offset the cost of maintaining the database. Another commenter recommended that the public sector and large health plans pay fees to a public-private sector trust organization. The fees would represent their proportion of the total health benefit dollars; the trust organization would administer various databases required by the HIPAA standards not solely the NPS. One commenter suggested Federal funds be used initially, with the enumeration entity eventually becoming self-sufficient.
Federal funds will support the enumeration process and the NPS, at least initially. The data dissemination process is discussed in section II. Comment : Some commenters supported the phases of enumeration as described in the May 7, , proposed rule. Many commenters stated that health care providers that do not conduct the transactions specified in HIPAA should be enumerated at the same time as all other health care providers—all health care providers must be equally able to receive NPIs.
Many of these commenters believed that costly dual systems would have to be maintained one for health care providers with NPIs and one for those without and confusion in the marketplace would be created if paper processors did not also receive NPIs within the same time frame as electronic processors. Other commenters suggested that NPIs be issued on a first-come, first-served basis.
Some commenters suggested enumeration phases by health care provider type or by geographical region of the country. Response : The NPS will be stress tested, but even successful passage of the stress test will not enable all health care providers to apply for and be assigned NPIs at the same time. Covered health care providers are required to use NPIs where those identifiers are required in standard transactions. We expect that covered health care providers will be the first to apply for NPIs. We estimate that, on the effective date of the NPI, approximately 2. They may apply for NPIs beginning on the effective date, which is May 23, Covered health care providers must begin to use their NPIs in standard transactions no later than May 23, We estimate that, on the effective date of the NPI, the number of health care providers that typically do not conduct standard transactions will be approximately 3.
A few examples of these health care providers are registered nurses employed by hospitals or other facilities, X-ray and other technicians, and dental hygienists. These health care providers may apply for NPIs at any time after the effective date of this final rule. However, because there is no requirement for these health care providers to use NPIs, we do not expect them to apply for NPIs as soon as those that conduct standard transactions or those that must be identified in standard transactions.
Bulk enumeration is a term used to mean mass-enumeration of a large number of health care providers, all at one time, from a database or file that uniquely identifies them in a way consistent with the identification criteria in this final rule. Bulk enumeration would eliminate the need for those health care providers to apply for NPIs.
For example, bulk enumeration might involve a specific classification of health care providers that comprises the membership of a large professional organization, or it could involve different classifications of health care providers that are employed by one large organization health care provider. In both of these examples, the health care providers to be enumerated may or may not be covered entities. This enumeration could occur at any time, if it is feasible. HHS, along with the other affected entities, and working within the requirements of the Privacy Act, will determine the feasibility of bulk enumeration.
Any health care provider that would be enumerated in this way will be notified. It is true that some health plans may have to maintain—for internal purposes—dual health care provider numbers: the NPI and the number s issued to health care providers by the health plans themselves.
Health plans impose this burden on themselves in accommodating their own internal operational needs. We expect that health plans may decide to use NPIs for additional purposes beyond those required in this final rule. Comment: The majority of commenters made it clear that NPIs must be assigned and the NPS fully and successfully tested well before the compliance date. Response: We agree.
The speed of assignment of NPIs will be dependent in part on the complete, correct, and timely submission of the NPI applications. Comment: Several commenters stated that the application forms for NPIs should be retained indefinitely in a manner where the signatures or certification statements could be verified if necessary.
Commenters stated that signatures or certification statements could be useful in prosecuting a health care provider that knowingly requested more than one NPI for itself. Response: The NPI application forms will contain a statement whereby the signer attests to the accuracy of the information on the application. Paper applications will be maintained indefinitely for signature or certification statement verification and audit purposes.
Those electronic applications that are successfully processed that is, the health care provider is assigned an NPI will be maintained indefinitely in a manner whereby certification statements can be verified if required. Comment: Several commenters asked that the NPI application form be designed to accommodate updates to health care provider data. Response: We believe this is a good suggestion, particularly because all of the information that will be required on the application for an NPI will have to be updated if changes occur. Therefore, we will attempt to design a form that can serve both application and update purposes.
One entity will be given enumeration functions under the direction of HHS option 1 as presented in the May 7, , proposed rule to enumerate all eligible health care providers who apply for NPIs. There are many advantages in using a single entity, which were discussed in the comment and response section above. The enumeration function and the development and operation of the NPS will be federally funded, at least for the foreseeable future.
Information on Provider taxonomy codes is available at www. Only one physical location address will be associated with each NPI. Two commenters suggested that we explore the need for an electronic data interchange EDI identifier for transaction routing. The HI Service protects individual privacy through legislation and technical security and access controls. Report the corresponding Primary Provider Taxonomy Code for the practice and each individual participating practitioner at the office location as reported on the NPI application s. This process takes approximately 20 minutes to complete. Response: WEDI is named in the Act as an external group with which the Secretary must consult in certain circumstances in standards development.
Under this final rule, health care providers will not be charged a fee to be assigned NPIs or to update their NPS data. We will attempt to design the NPI application form in order to also accommodate updates. We expect that the use of modern technology to receive and process applications for NPIs and to apply updates to the NPS records of enumerated health care providers will greatly reduce our earlier estimates.
In addition, the limited validation by the NPS of data reported by health care providers will further reduce NPS costs. Before enumeration begins, the NPS will be fully tested.
We will strive to ensure that the NPS functions properly and guards against assigning the same NPI to more than one health care provider, assigning more than one NPI to the same health care provider, and re-using NPIs assigning to a health care provider an NPI that had at one time been issued to another. Health care providers may apply for NPIs beginning on the effective date of this final rule. At this time, we do not expect bulk enumeration of health care providers, except possibly of Medicare providers, as discussed earlier.
HHS will explore the feasibility of other such enumerations. If considered feasible, the affected health care providers will be notified and will not have to apply for NPIs. We will consider the feasibility of allowing health care providers to designate authorized representatives to handle their NPI applications and updates.
Applications for NPIs and updates will be retained by HHS indefinitely in a manner in which signatures on paper applications or certification statements on electronic applications can be verified if required. The preamble of the May 7, , proposed rule discussed approved uses of the NPI.
We did not receive comments that objected to those uses. By 24 months after the effective date of this final rule, covered health care providers, health plans except for small health plans , and health care clearinghouses must use the NPI in standard transactions. Small health plans must do so within 36 months of the effective date.
Covered health care providers must disclose their NPIs to other entities when these entities need to include those health care providers' NPIs in standard transactions. We encourage all other health care providers to do the same. The NPI may also be used for any other lawful purpose requiring the unique identification of a health care provider. It may not be used in any activity otherwise prohibited by law.
Examples of permissible uses include, in addition to the above, the following:. Few comments were received on the System of Records Notice. Comment: One commenter believes that the data collected to assign NPIs to physicians should be kept to an absolute minimum. Data that are not required for enumeration or legitimate administrative purposes should not be collected. Data released beyond HHS must be released in accordance with the provisions of the Privacy Act, insofar as that Act applies to the data in question, and the Freedom of Information Act, as appropriate.
Most of the data collected to enumerate an individual should not be publicly available. Another commenter was concerned that removal of a health care provider's record from the NPS could result in the re-issuance of that health care provider's NPI to another health care provider. Removal of a health care provider's records at some point after the health care provider's death is reasonable, as long as there are guarantees that the health care provider's NPI will never be used by another health care provider or re-issued to another health care provider.
Response: In section II. Below is a summary of how the implementation of the NPI will affect health care providers, health plans, and health care clearinghouses. At this time, bulk enumeration of health care providers is not expected to occur. If, however, it is determined to be feasible, we will populate the NPS with data from Medicare provider files. If bulk enumeration were to occur, the affected health care providers would be notified of their NPIs and would not have to apply for them.
Health care providers that are not covered entities are encouraged to apply for NPIs. Health care providers will submit a paper application or, if feasible, will have the option of applying for NPIs via the Internet. We recommend that health care providers notify the health plans in which they are enrolled of any changes at the same time they notify the NPS of these changes.
This recommendation does not preclude health plans from requiring notification of updates within a shorter time frame. We encourage health care providers who have been assigned NPIs but who are not covered entities also to notify the NPS of changes in their NPS data within 30 days of the changes. Covered health care providers must use their NPIs to identify themselves and their subparts, if appropriate, on all standard transactions when their health care provider identifiers are required. We encourage all health care providers and subparts that have been assigned NPIs to do the same.
Covered health care providers must disclose their NPIs and those of their subparts to entities that need the NPIs to identify those health care providers in standard transactions. Covered health care providers must require their business associates, if they use them to conduct standard transactions on their behalf, to use their NPIs and the NPIs of other health care providers and subparts appropriately as required by those transactions.
Covered health care providers that are organization health care providers with subparts as described earlier in this preamble must ensure that, when NPIs are assigned to subparts, either the covered health care provider or the subpart 1 uses the NPIs of the subparts on all standard transactions when their health care provider identifiers are required, 2 discloses their NPIs to entities that need the NPIs to identify those subpart s in standard transactions, 3 communicates changes in required data elements of the subparts to the NPS, and 4 requires business associates of the subparts, if they use them to conduct standard transactions on their behalf, to use their NPIs and the NPIs of other health care providers and subparts appropriately as required by the transactions that the business associates conduct on their behalf.
Health plans must use the NPI of any health care provider or subpart that has been assigned an NPI to identify that health care provider or subpart on all standard transactions when the NPI is required. All plans except small health plans have 24 months from the effective date of this final rule to implement the NPI; small health plans have 36 months. HIPAA does not prohibit a health plan from requiring its enrolled health care providers to obtain NPIs if those health care providers are eligible for NPIs as discussed earlier in this preamble.
Health care clearinghouses must use the NPI of any health care provider or subpart that has been assigned an NPI to identify that health care provider or subpart on all standard transactions when the NPI is required. In section IV. Below are the questions as posed in the May 7, , proposed rule followed by a summary of the comments and our responses:. Responding yes: Some commenters stated that they need to capture the multiple practice addresses of a health care provider for their business functions.
They believe it would be best to do this once in the health care provider's NPS record, rather than in many local systems. Responding no: A large majority of commenters stated that the NPS should not capture any practice addresses or should capture only one physical location address per NPI. Some of these commenters believed that each location where a health care provider practices needs to be identified, but they believed locations should receive separate identifiers, rather than be captured as multiple addresses in the health care provider's NPS record.
Many other commenters noted that health care provider practice addresses change frequently and that address information will be burdensome and expensive to maintain and will be unlikely to be maintained accurately at the national level. They believe that, if needed, it should be collected and maintained in local systems. Response: The NPS will capture the mailing address and one physical location address for each health care provider. Only one physical location address will be associated with each NPI. Practice addresses would be of limited use in the electronic matching of health care providers.
The volatility of practice address information would make maintenance of the information burdensome and expensive. Collecting only one physical location address minimizes the burden of data collection and maintenance, while providing an Start Printed Page address where the health care provider can be contacted in situations when a mailing address is insufficient. For example, a mailing address containing a Post Office box number cannot be used for mail delivery by other than the United States Postal Service. Responding yes: A small number of commenters recommended that the NPS assign location codes.
Most of these commenters were health plans that need to identify all the practice addresses of a health care provider. They want to use location codes as pointers to these addresses in a health care provider's NPS record. Responding no: A large majority of commenters stated that the NPS should collect only one physical location address of each health care provider and should not assign location codes. If only one physical location address is collected, there is no need to assign location codes to distinguish multiple practice addresses. Respondents noted several technical weaknesses of the proposed location code.
They stated that the format of the location code would allow for a lifetime maximum of location codes per health care provider, and this number may not be adequate for health care providers with many locations. The location code would not uniquely identify an address; different health care providers practicing at the same address would have different location codes for that address, resulting in complexity, rather than simplification, for business offices that maintain data for large numbers of health care providers.
Response: The combination of the NPI assignment strategy described earlier in this final rule and the data elements contained in the standard claim and equivalent encounter information transaction eliminate the need for location codes. The NPS will not establish location codes. Responding yes: Some commenters responded that they need to be able to associate organization health care providers who are group practices with the individual members of the group. They believe this association can most efficiently be maintained once in the NPS, rather than in many local systems.
Responding no: A large majority of commenters noted that health care provider membership in groups changes frequently and that this information will be burdensome and expensive to maintain and will be unlikely to be maintained accurately at the national level. Some health plans recognize contractual arrangements that may not correspond to groups.
Commenters believe that, if needed, membership in groups should be collected and maintained in local systems. Response: We agree that the NPS should not link the NPI of an organization health care provider that is a group practice to the NPIs of individual health care providers who are members of the group. The large number of members of some groups and the frequent moves of individuals among groups would make national maintenance of group membership burdensome and expensive.
Contractual arrangements would be impractical to maintain nationally and would most likely differ from health plan to health plan. Most organizations that need to know group membership and contractual arrangements prefer to maintain this information locally, so that they can ensure its accuracy for their business purposes. Responding yes: A large majority of commenters stated that a distinction between organization and group health care providers would be artificial and would serve no purpose. Responding no: Some commenters stated that organization and group health care providers should be distinguished in the NPS.
None of these commenters suggested different data that should be collected for a group health care provider, as opposed to an organization health care provider. We believe that most of these comments reflect a recommendation that group health care providers receive NPIs rather than a recommendation that different data be collected for group health care providers, as opposed to organization health care providers.
Response: No commenter suggested that different data be collected for a group practice than for an organization health care provider and a strong majority of commenters stated that the same data should be collected. We agree that the NPS should collect the same data for group and organization health care providers. Groups will be enumerated as organization health care providers. In the May 7, , proposed rule, we presented two alternatives for the structure of health care provider data in the NPS.
It would assign a location code for each practice address of an individual or group health care provider. Organization and group health care provider records would have different associated data in the NPS. Group health care providers could have individuals such as physicians listed as members of the group, and the NPS would link the NPIs of group health care providers to the NPIs of the individuals that make up the group.
It would not assign location codes.
It would not collect different data for organization and group health care providers. Comment: A majority of respondents preferred Alternative 2. Response: The comments on the four preceding questions and on the two alternatives indicated a strong preference for Alternative 2. We agree with commenters that Alternative 2 will provide the data needed to identify the health care provider at the national level.
We agree that the NPS record will be based on the data described in Alternative 2. The data structures discussed below apply to every entity that is assigned an NPI. The mailing address and one practice address physical location will be collected by the NPS for each health care provider. One physical location address will be associated with each NPI. Because only one physical location address will be collected per health care provider, location codes will not be necessary and, therefore, will not be established by the NPS. Group practices often have many members, and individual health care providers often move from group to group.
Maintenance of this information on a national level would be difficult and costly. Many health plans prefer to Start Printed Page collect and maintain this information themselves. The NPS will collect the same data from group health care providers as it will collect from organization health care providers.
Group practices will be considered organization health care providers and will be enumerated as organization health care providers. We will design the NPS along the lines of Alternative 2 as presented in the May 7, , proposed rule. We solicited comments on the inclusion and exclusion of those data elements and the inclusion of other data elements that the public believed appropriate.
We asked how the NPS could be designed to make it useful, efficient, and low-cost. In that same section, we also posed data questions and discussed options for NPS data structures. Section II. As a result of those decisions, some data elements that were included in the list of proposed data elements published in the May 7, , proposed rule will not, in fact, be included in the NPS database. Therefore, the information in section II. In the preamble of the May 7, , proposed rule, in section V. The May 7, , proposed rule contained a table indicating the level of dissemination of the NPS data elements.
We proposed that we would charge fees for data and data files, but that the fees would not exceed the costs of dissemination 63 FR We solicited comments on the information that should be available in paper and electronic formats and the frequency with which information should be made available. Comment: An overwhelming number of commenters said that the NPS should contain only the data elements required to communicate with and uniquely identify and assign an NPI to a health care provider. They believed this information should be the kind that could effectively be maintained at the national level, leaving the more complex and volatile data to health plans to capture and maintain, as they currently do.
Many commenters listed the specific data elements that they recommended we remove from the list presented in the May 7, , proposed rule. The majority of commenters believe that, as a result of the removal of the data elements not needed for enumeration and communication, the NPS would be easier and less expensive to maintain and would operate more efficiently. Response: To be valuable, the NPS must be accurate, up to date, and meet its intended purpose in the most feasible way.
The NPS must collect information sufficient to uniquely identify a health care provider and assign it an NPI and must collect information sufficient to communicate with a health care provider. The data elements that we have retained are necessary to uniquely identify and communicate with a health care provider. Our decision to reduce the composition of the NPS to the data elements needed for unique identification and communication removes many of the data elements that were proposed to comprise the NPS in the May 7, , proposed rule.
The comments and responses that follow contain additional information and rationale concerning our decision to include or exclude certain data elements. Comment: Some commenters said that collecting but not validating certification or school information would make that information meaningless. Most commenters did not believe the NPS should collect certification or school information in the first place because it would not be useful in uniquely identifying the individual applying for an NPI. They believe that collection and validation of this information should continue to be done by health plans in their health care provider enrollment processes.
Most commenters supported the collection of credential designation s for example, M. Response: We agree with commenters that it would be costly to collect, validate, and maintain certification and school information.
We do not believe the NPS should replicate unnecessarily the work carried out by health plans. We agree that health plans, which do this work now, should appropriately continue to do so. The NPS will capture an individual health care provider's license number if appropriate , the State which issued the license multiple occurrences of both data elements , and the credential designation s. This data element was renamed to make it compatible with X12N HIPAA data dictionary naming conventions and also to avoid giving the impression that the NPS will be validating the credentials.
The license number and State in which it was issued will be useful to health plans in matching NPS records to their health care provider files. As a result of the decision not to collect certification and school information, the following data elements will not be included in the NPS:. They believed this was needed to match NPS records to health plans' health care provider files and that it could help in unique identification. Response: We agree that the numbers used to report income taxes will be Start Printed Page useful in uniquely identifying health care providers.
One commenter wanted to know where sanction data would be housed and who would maintain these data. Response: The NPS will not contain sanction data or indicators that sanction data exist. Sanction data were not included in the data element list published in the May 7, , proposed rule. Response: The NPS will not capture this or similar information. The uniqueness of the health care provider can be established without this information. This information would more appropriately be collected by health plans.
Comment: A number of data elements were suggested to be added to the NPS. Response: The May 7, , proposed rule did not propose that the NPS collect health care provider ownership information. This information is volatile and already resides on most health plans' health care provider enrollment files. Practice type control information is not required to uniquely identify or classify a health care provider for NPS purposes; therefore, it will not be included in the NPS.
By capturing this information, we take into account the specialty classifications as required by HIPAA. Another commenter stated that health plans will use the health care provider's mailing address as the pay-to address. The composition of the NPS will be revised if necessary in the future. Comment: Several commenters suggested adding the name of the establishing enumerator or agent and the name and telephone number of the enumerator who made the last update to the NPS. They believe that this information would help ensure the accuracy of the database by preventing multiple enumerators from updating or attempting to update the same records.
Response: As discussed in section II. The decision to use a single enumerator renders the data elements proposed by these commenters unnecessary. Fact of death and resulting deactivation date will be captured in the two new data elements. There may, however, be an unusual circumstance that would justify a health care provider's request to be issued a new, different NPI.
When a user retrieves the NPS record of a health care provider, either of those fields may contain data. If neither field contains data, the health care provider has had only one—its original—NPI. Response: We expect that the NPS will be designed to associate dates with the information about a health care provider, thus creating a history of a health care provider's record.
When changes are made to a health care provider's telephone number or address, Start Printed Page that health care provider's record will include the dates of those changes. We believe it will be more accurate to include a date to reflect each time a change is made in this information. Response: As explained earlier in section II. These will be optional and repeating NPS data elements.
Comment: Several commenters suggested the NPS retain the health care provider mailing and health care provider practice provider location phone number, facsimile number, and electronic mail address only during the initial assignment of NPIs, and then discontinue maintenance of this information.
Response: These data elements are needed for communication with the health care provider. HHS may need to communicate with a health care provider at any time during the implementation period or after. Therefore, these data elements will be maintained beyond the initial assignment of NPIs. Response: The data element table appearing in the May 7, , proposed rule did not indicate repeating fields. In the National Provider System Data Elements table at the end of this section, repeating fields are noted as such.
These repeating fields are either optional or situational and will not be validated. They did not believe it would be accurately reported. Response: We understand and appreciate the comments stating that the NPS should be capturing only what is needed for unique identification of and communication with a health care provider. While collection of race and ethnicity data could support a number of important research activities, this information is not needed to uniquely identify a health care provider; thus, we have concluded that the NPS is not the appropriate vehicle for collecting this information.
Therefore, we will not collect these data elements even on an optional basis. Response: Certain information about health care providers that is desirable to uniquely identify them in order to assign NPIs cannot be required to be furnished. A health care provider may choose not to report a former name or a professional name. We believe the mapping capability and naming convention compatibility are essentially what the commenters wanted and believe we have satisfied their concerns. Comment: Two commenters suggested that the Drug Enforcement Administration DEA number be collected from health care providers that have one.
Comment: Several commenters suggested that we publish a data model and record layout or both describing in detail the data elements, field lengths, format, repeating fields, and required and situational fields. Comment: Several commenters said an audit trail of NPI updates is needed for qualified users. This would indicate which enumerator updated which fields.
Response: The NPS will construct an audit trail. We expect that the audit trail would include the date a change was made, the old value, the new value, and the initiator of the change. As stated in section II. Extracts containing NPS changes will be made available in HHS-determined format and media to satisfy requests from approved users see later discussion in this section of the data dissemination strategy.
Comment: Several Medicaid State agencies suggested that the Healthcare Provider Taxonomy Code set contain all health care provider types and specialties needed by Medicaid plans. Another commenter asked that the code set reflect services provided by pharmacists. Another stated that the code set did not contain a category for pain medicine. Several other commenters said the taxonomy code set is inconsistent. Response: Until recently, this code set was maintained through an open process by the National Healthcare Provider Taxonomy Committee for use in Accredited Standards Committee X12N standard transactions.
It is now maintained through an open process by the National Uniform Claim Committee. The web site contains information on how changes to the code set can be requested. Comment: Many commenters supported the creation of an industry-wide forum to determine the data element content, identify the mandatory and optional data elements, and determine the data dissemination requirements of the NPS.
They recommended that WEDI foster such a group. Response: WEDI is named in the Act as an external group with which the Secretary must consult in certain circumstances in standards development. To address these issues, WEDI formed several workgroups, which consisted of representatives from every aspect of the health care industry. We have considered these comments in developing this final rule. Comment: Most commenters did not favor the two-level data dissemination approach presented in the May 7, , proposed rule but favored instead a three-level approach:.
Response: In order to keep costs low, we must make the NPS data dissemination strategy as efficient and uncomplicated as possible. The number of formats and access options will need to be limited.
We view the NPS as a health care provider identification and enumeration system, capturing the information required to perform those functions and disseminating information needed by health plans and other entities to effectively carry out the provisions of HIPAA. We agree with the majority of commenters who stated that health plans and certain other health care industry entities require NPS data, including some data that are protected by the Privacy Act, in order to effectively conduct HIPAA transactions.
Privacy Act-protected data are those that reveal or could reveal the identity of a specific individual when used alone or in combination with or linked to one or more data elements. Comment: Some commenters suggested that a health care provider be able to access its own NPS data through the Internet to ensure its accuracy and to facilitate updating the information.
Response: This comment will be considered in the design of the NPS; if it is determined to be feasible, this access will be made available. Comment: Several commenters supported charging reasonable fees or subscription rates for web-based data access options; for example, HHS could charge an annual subscription fee for unlimited downloads and a different subscription fee for monthly downloads. Some commenters asked if on-line access charges would be based on time or on a per file access basis.
Some commenters believed that usage fees should not be limited to the cost of producing the data but should be linked to the costs and value of establishing and using the NPS. Many commenters stated that the enumerator s should not have to pay for NPS data. One commenter, who had suggested the enumerator be a public and private sector trust, suggested that dissemination fees be established and administered by the public and private sector trust. Response: The design of the NPS will facilitate making information available in an efficient manner, which will involve the use of the Internet.
We are reviewing the issue of charging fees, and intend to consider charging fees to the extent our authority permits. The data element table is not intended to be used for data design purposes. During NPS design and development, the names and attributes of the data elements may be revised. We are including this listing to show readers the kind of information that we expect will be collected about health care providers or that will be NPS-generated for example, the NPI about health care providers. The table does not include systems maintenance or similar fields. Description of the information contained in each column of this table:.
Description: The definition of the data element and related information.