NPI Number Meaning, Uses, and Benefits

Are you a non-emergency medical transportation (NEMT) operator who bills Medicaid or Medicare? If so, you'll need an NPI or National Provider Identifier number. It's based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

Healthcare providers use the standard identification system for processing HIPAA-covered transactions. It makes verifying and processing transactions more efficient and reliable. Covered individuals and organizations that file insurance claims must use it. This includes physicians, nurses, dentists, insurers, healthcare clearinghouses, and suppliers. Even NEMTs that transport Medicaid and Medicare beneficiaries must reference NPI numbers.

Contents:

• What Is an NPI Number?
• How NPI Started
• Why the NPI Number Is Important
• Who Needs It: Do NEMT Providers Need an NPI Number?
• Types of NPI numbers
• How To Get an NPI Number
• How To Find an NPI Number
• Benefits of NPI in NEMT
• How RouteGenie Optimizes NEMT Operations
• Accelerate Next-Level Growth

What Is an NPI Number?

The National Provider Identifier number is a unique, government-issued 10-digit number. It serves as the standard identification code for individual healthcare providers.

This identifier doesn't replace state license numbers or tax identification numbers. But previous and present healthcare transactions, billings, and health claims must use it.

NPI numbers don't need renewal or modification, even if one's profession changes. When NEMT businesses stop operations and serve another state, the NPI stays.

How NPI Started

The Centers for Medicare and Medicaid Services (CMS) established NPI in 1993. The goal was to create a standardized identifier system. It was also meant to optimize the recording, verification, and reporting of claims. The NPI Final Rule became the standard identifier on January 23, 2004.

Before the NPI, there were no standard identifiers. Administrative processes were inefficient, while claims submissions were full of errors.

Why the NPI Number Is Important

Relying on personal data and other non-standard references poses several risks. Fraud, inaccuracies, errors in claims and health data communication were all too common.

In contrast, NPI numbers promote accountability. They also enable more accurate data communication management. Especially across entities like the CMS, doctors, hospitals, medical suppliers, NEMT providers, etc.

Who Needs It: Do NEMT Providers Need an NPI Number?

Covered healthcare providers, all health plans, and healthcare clearinghouses must use NPIs. HIPAA-covered healthcare and healthcare-related financial transactions rely on them.

These include healthcare professionals like doctors, nurses, dentists, hospitals, and healthcare facilities. Group practices, health insurance organizations, NEMTs, and other HIPAA transactions also use NPIs.

Types of NPI numbers

The government issues two types of NPIs: 

Type 1 NPIs

This type is for individuals like physicians, nurses, or dentists, including individual NEMT business operators. Type 1 NPIs are personal and used by eligible healthcare service providers.

If you are an NEMT operator licensed to operate in a state and bill Medicare, Medicaid, and other healthcare insurance providers, you must have this type of NPI number.

Type 2 NPIs

Type 2 NPIs are for organizations, such as hospitals, group practices, supply networks, and healthcare facilities. Organizations may apply for multiple NPIs on behalf of their covered employees.

How To Get an NPI Number

Submit an application and file online or by filling out and mailing a form downloaded from the National Plan and Provider Enumeration System (NPPES), the system in charge of issuing NPIs.

How To Find an NPI Number

Anyone can verify an NPI number via the NPPES NPI Registry. Enter the NPI number, provider name, or organization name before searching. This free government tool will return search results that can be downloaded or integrated into other electronic health systems.

Search result details include the NPI number, the provider’s first and last name, NPI type, taxonomy code, address, and contact number.

Benefits of NPI in NEMT

For NEMT operators that bill Medicare, Medicaid, and private insurance providers, having an NPI number benefits their businesses and services.

Efficiency in Billing

Using an NPI number makes filing and processing claims more efficient, transparent, and straightforward. This reduces delays and denied claims.

Easy Access To Financing

You can apply for loans and grants to fund your business expansion, whether it’s acquiring another vehicle for your fleet or purchasing NEMT software to enhance your services.

Proof of Legitimacy

If you obtain an NPI number, this means that the federal government has verified your company as a legitimate business entity. It lends credibility to your NEMT business, helping passengers, healthcare partners, suppliers, and government agencies trust you.

Efficient Claims Submission Management

With an NPI number, claims submission and processing become more efficient, especially with electronic submission software like RouteGenie. Our software solution helps reduce errors, delays, and denials while speeding up reimbursements. Moreover, RouteGenie facilitates the secure transfer of health data to various entities.

Compliance

Having an NPI number complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). NPIs are shared between covered providers or any entity that may need them for billing purposes. Failure to comply will result in business issues since many states require NPI numbers from NEMT operators and those covered by the mandate.

Free and Requires No Renewal

Applying for an NPI is free and easy. It only takes about 20 minutes to file an NPI online application via the NPPES. Upon completion of the application process, you can receive your NPI number after 10 days.

How RouteGenie Optimizes NEMT Operations

With an NPI number, you can get the full benefits of RouteGenie—an NEMT software designed to be your all-in-one team. With capabilities covering routing, dispatching, and billing, you can optimize your operations, get claims approved, and satisfy your passengers with our HIPAA-compliant billing system.

The system utilizes and transmits your data—including your NPI identifier—to Medicaid, Medicare, and other insurance providers for billing. Relevant parties can then process your claim based on your NPI number, knowing that your operations are legitimate.

RouteGenie can generate electronic billing files, including 837P files and CMS 1500 forms. It can also print invoices and track payments.

Accelerate Next-Level Growth

Maximize the benefits as an NEMT provider with an NPI number by adopting software that’s designed to enhance your operations and growth. Aside from billing, RouteGenie takes care of other operational aspects, such as:

• Dispatch management
• Data integrations
• Fleet management and compliance
• Scheduling optimization
• Automated communication systems with passengers
• Driver and customer apps
• HR/administrative capabilities

Enjoy these benefits and more. Contact us today for a free demo.