NPI (National Provider Identifier)
DefinitionThe unique 10-digit number HIPAA requires on every electronic claim. Dietitians get one free from CMS's NPPES; Type 1 is individual, Type 2 organization.
The NPI is a HIPAA standard identifier: a 10-position, intelligence-free number that covered providers must use in all standard transactions, including claims and eligibility checks (CMS: NPIs). You apply, update and look NPIs up in NPPES, at no charge.
Two types:
- Type 1 (individual): yours, for life, regardless of where you work. Every dietitian who bills needs one.
- Type 2 (organization): for an entity such as an LLC or group practice that bills under its own tax ID.
Where NPIs appear on an MNT claim:
- Rendering provider: the dietitian who saw the patient.
- Billing provider: you (Type 1) or your entity (Type 2), matching what the payer has on your contract.
- Referring provider: required for Medicare MNT, since the referring physician's NPI goes on every claim.
Most NPI denials are mismatches: the billing NPI and tax ID on the claim don't match the payer's file, often after forming an LLC.