 | LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH | | | Policy 106.15 Updating and Maintaining National Provider Identifier Application Data
| | Policy Category: Administrative | | Distribution Level: Directly Operated Programs and Contracted Agencies | | Responsible Party: Compliance, Privacy, and Audit Services | | | | Approved by Marvin J. Southard, DSW, Director, on June 1, 2008 | | | |
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| I. PURPOSE
| | The purpose of this policy is to ensure that Los Angeles County Department of Mental Health (DMH/Department), its employees, contractors (legal entities and Fee-For-Service [FFS] providers) and their employees are aware that they are responsible for ensuring that their National Provider Identifier (NPI) application data is kept up to date.
| | II. DEFINITIONS
| | National Provider Identifier (NPI): The NPI is a 10-position numeric identifier, with a check digit in the 10th position and no intelligence about the health care provider is in the number. When referring to intelligence about the health care provider, this means that looking at the number, no one can tell where the services are provided, the type of provider, or taxonomy. The numbers are randomly assigned. An NPI replaces existing legacy provider numbers used to identify a rendering provider (an individual – Type 1 NPI) to a health plan, or an organizational provider (Type 2 NPI). These numbers are used in electronic claiming transactions.
National Plan and Provider Enumeration System (NPPES): The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. The NPPES collects identifying information on health care providers and assigns each a unique NPI.
| | III. POLICY
| | DMH, its employees, contractors (legal entities and FFS) and their employees will comply with Health Insurance Portability and Accountability Act (HIPAA) requirement (CFR 45, Part 162), effective January 23, 2005, i.e., DMH and its employees and contractors will update their NPI application data within 30 days of the changes.
Office of Inspector General (OIG) and Centers for Medicaid and Medicare Services (CMS) are responsible for ensuring compliance with HIPAA Administrative Simplification rules and regulations. Should the OIG and/or CMS find that NPI application is not up to date, the OIG and/or CMS may fine the responsible party.
| | IV. PROCEDURES
| Procedures - Updating and Maintaining NPI Application Data
| | V. AUTHORITY
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