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 the voluntary submission of the prescriber’s National Provider Identifier (NPI) will not be implemented July 15, 2009. Please continue to submit the prescriber’s state license number in "Prescriber ID" (Field 411-DB) on all claim transactions.

HHSC recommends that Texas Medicaid pharmacy providers implement the following activities immediately:

• Identify processes and systems that are affected by the change from physician/practitioner's state license number to NPI.
• Develop implementation plans.
• Educate staff.

Provider NPI

The Centers for Medicaid and Medicare (CMS) Services requires the pharmacy National Provider Identifier (NPI) to identify pharmacy providers on all standard electronic transactions beginning May 23, 2008. Failure to use the pharmacy provider's NPI number on claims submitted to the Texas Vendor Drug Program will cause claims to reject.

Where to place the pharmacy NPI on the electronic transmission:

• Enter "Ø1" in "Service Provider ID Qualifier" (Field 2Ø2-B2).
• Enter your store’s 10-digit NPI number in "Service Provider ID" (Field 2Ø1-B1).