National Plan

1
National Plan Provider Enumeration

• By Charles Waldhauser, HHS/CMS/Office of
  Financial Management
• Prepared September 18, 2004

2
National Plan Provider Enumeration

• NPI Background
• NPPES Development
• Enumerator
• Implementation Issues

3
NPI Background

• Effort started in 1993
• HIPAA passed in 1996
• NPRM published in January, 1998
• Final Rule published 1/23/2004
• 16-month delay in effective date (5/23/05)
• Must be implemented by 5/23/2007(8)

4
NPPES Development

• Contract awarded to AMS 12/1/00 for design and
  development
• Will accommodate NPI and NPlanID
• Target date May, 2005 for NPI
• Will have web-based application
• Minimal validation involved
• Will attempt to bulk load data

5
Enumerator

• Need contractor to handle day-to-day operations
• Will handle paper applications, customer support
• Will handle 4 million providers and 3 million
  health plans
• RFI was issued this summer
• Target date for contract award

6
Other Issues

• Number Issues 1 per individual/group
  organizations according to subpart needs
• Provider/Industry education
• Crosswalk files
• Data for health plans and clearinghouses
• Data use agreements for unknown number of
  entities?
• Mechanism for release of data
• Privacy concerns
• SSN not mandatory