The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA.

These are the Vendor Drug requirements for the:

• Provider National Provider Identifier
• Prescriber National Provider Identifier

Resources:

Prescriber NPI

Support for submission of the Prescriber National Provider Identifier (NPI) will be implemented in late 2010, and providers will be notified of the date on which the Prescriber NPI becomes voluntary.  Please continue to submit the prescriber’s state license number on all claim transactions until that time.

When implemented, Vendor Drug Program will allow pharmacies the option to submit either the prescriber’s 5-character Texas State License number or the Prescriber 10-digit National Provider Identifier (NPI) on all billing transactions:

Prescriber State License number 

• 5-character alphanumeric State License in “Prescriber ID” (Field 411-DB).
• “Ø8” in “Provider ID Qualifier” (Field 466-EZ).

Prescriber NPI 

• 10-digit Prescriber NPI in “Prescriber ID” (Field 411-DB).
• “Ø1” in “Provider ID Qualifier” (Field 466-EZ).

If a pharmacy provider submits the Prescriber NPI prior to implementation then the claim will reject.  This optional period will last for at least three months, and providers will be notified of the date on which the Prescriber NPI becomes mandatory.

Provider NPI

Please refer to the Vendor Drug Pharmacy Provider Procedure Manual and payer sheets for standard electronic transaction requirements for the Provider NPI.