The National Provider Identifier (NPI) final rule was published on January 23, 2004, by the Federal Government as part of the Health Insurance Portability and Accountability Act (HIPAA). The rule requires the NPI as the standard unique identifier for health care providers. The rule requires HIPAA-covered health care providers, clearinghouses, and health plans to use this identifier in all HIPAA-covered transactions starting May 23, 2007.

On April 2, 2007 Centers for Medicare/Medicaid Service (CMS) announced their implementation of a twelve-month contingency plan for covered entities who will not meet the May 23, 2007 deadline for compliance with the NPI regulations under the Health Insurance Portability and Accountability Act (HIPAA) 1996.

Central Coast Alliance for Health (the Alliance) meets the definition of a health plan and is required to support the NPI requirements in order to continue to pay providers, in an accurate and timely manner, for services rendered. Effective May 23, 2007, the Alliance will accept the NPI(s) or Alliance provider identifier number(s) (e.g. Medi-Cal billing number) on most electronic claim transactions and most paper-based claims.

Conversion from the Alliance provider ID number(s) to NPI(s) should be viewed as a 1:1 relationship. The Alliance strongly recommends that providers obtain one NPI for each Alliance provider identifier number that is currently billed to the Alliance. Enumerating at this 1:1 level will guarantee accurate reimbursement and adjudication of claims.

If any provider decides not to enumerate at a 1:1 relationship between the Alliance provider identifier number and NPI, then providers are required to bill using their current Alliance provider identifier number until further notice.