Glossary · Coding and compliance
What is an NPI?
The National Provider Identifier is the 10-digit number that identifies every healthcare provider in claims and other HIPAA transactions: Type 1 for individuals, Type 2 for organizations.
Example · fictional data
The NPIs on one claim, each in its own role.
Providers on a claim
| Role | Who | NPI type |
|---|---|---|
| Billing provider | Example Family Medicine | Type 2, organization |
| Rendering provider | The physician who saw the patient | Type 1, individual |
| Referring or ordering provider | The physician who ordered the test | Type 1, individual |
| Service facility | Where the service happened, if different | Type 2, organization |
- The tenth digit is a check digit, so a mistyped NPI usually fails validation before it reaches the payer, as a 277CA rejection.
Every provider who bills, renders, orders or refers in a HIPAA transaction needs an NPI. It’s issued once, through the national registry, and stays with the provider for life.
Where NPIs go wrong
- The billing provider’s NPI doesn’t match the one the payer has on file with the TIN.
- An individual NPI is used where the organization’s belongs, or the other way around.
- The rendering provider isn’t credentialed with the payer.
- The ordering provider isn’t enrolled in Medicare, which some services require.
Errors come back as rejections on the 277CA or as CO-16 denials with a remark code naming the provider.
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