Avera Health Plans

The National Provider Identifier (NPI)

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for healthcare providers. The HIPAA final rule adopted the National Provider Identifier (NPI) as this standard. The NPI is a 10-digit numeric identifier that does not carry information about healthcare providers, such as specialty or location of practice.

All healthcare providers—individual and/or organizational—are eligible for NPIs and must obtain an NPI to identify themselves in HIPAA standard transactions. By May 23, 2007, HIPAA-covered entities—including healthcare providers (individuals or organizations), healthcare clearinghouses and all but small health plans—must use only the NPI to identify HIPAA-covered healthcare providers in standard transactions.

Note: A sole proprietor/sole proprietorship is an individual and is elegible for a single NPI.  For more information about NPI, view the CMS NPI Fact Sheet.

Do you need to register for the NPI?  Visit the NPPES website to register.

Avera Health Plans’ claims system will maintain and match HIPAA transactions using providers’ NPIs, so please submit a listing of NPIs for providers in your office, as well as for your organization:

BY FAX:

   Attn: Network Services
   (605) 322-4540

BY E-MAIL:

  providers@averahealthplans.com