National Provider Identification Tool Kit
Share Your NPI
Once you have received your NPI from the enumerator, you must share it with entities with which you do business. Sharing your NPI identifier will enable trading partners to identify you in their systems and list you on their transactions. Some examples include:
Clinical Associates
Specialist practitioners will need the NPI number of referring physicians to submit electronic claims to a health plan. Hospitals will need the NPI number of admitting and attending physicians to submit electronic claims to a health plan. E-prescribing, electronic medical records, and regional health information organizations may be based upon NPI numbers to identify practitioners.
Consider including your NPI number on referral form documents.
Health Plans
Health plans will need your individual NPI and any group practice NPI identifiers in order to process claims and remits electronically. In addition, employer groups may need primary care physician individual NPI numbers to list on employee enrollment transactions.
To notify CDPHP:
Send an e-mail to NPI@cdphp.com and include the practitioner’s name, CDPHP provider ID, and NPI number. If you are submitting many NPI numbers, please attach an Excel spreadsheet to the e-mail message. If you have questions, you may contact Joe Leonard of CDPHP at (518) 641-3330.
To notify many payers at once: Consider updating your CAQH Universal Application with your individual practitioner NPI number. CAQH will make your information available to the plans you have authorized.
Pharmacies
Almost all retail pharmacy prescriptions are processed electronically through pharmacy benefit managers. Pharmacies will require the prescription writer’s NPI number in order to process the transaction when patients are getting medications.
Consider including your NPI number next to your DEA number on prescription pads and other referral documents.
Questions? Contact CDPHP Provider Services for additional information.