NPI Requirements in Illinois

All health insurance bills filed must contain a National Provider Identifier Number, or NPI. The NPI number links health care providers with standard medical transactions. Every doctor, hospital, special practice and clinic uses this assigned number on all claim forms submitted to insurance companies. The number identifies what kind of provider is rendering the services. Illinois providers are required to follow certain protocol when initializing an NPI number.

Federal Health Portability and Accountability Act

• Each state must enact its own NPI regulations in accordance with the Federal Health and Portability and Accountability Act. Implemented in 1996, the law gives federal protections for personal health information. It also permits the disclosure of personal information needed for specific patient care and other health-related purposes. Since March 1, 2008, all health care bills submitted electronically to any Illinois program must have a registered NPI number on the form. Any claims without the number will be denied and submitted back to the provider.

Qualifying Providers

• Heath care providers who must register an NPI number include individual professionals who bill in their own names and professional health care employees who have a payee billing on their behalf. The providers must also apply and register their NPI numbers with the Illinois Departments of Health Care and Family Services and the Illinois Department of Human Services. During the application process, the provider must submit a Taxonomy Code. This Code identifies what type of services the provider renders. Chiropractors, orthopedic surgeons and general practice physicians all have different codes that recognize the unique work that they do.

Registering

• If a provider who should register with an NPI has not done so already, then the provider needs to register as soon as possible. A web-based application can be accessed at www.illinoisnpi.com. After the application is processed, verification letters with the NPI information will be sent to the providers as well as the other payees. Providers should review the information and report any problems so that they may be addressed promptly. For those who do not have access to the Internet, you may file a paper enrollment application. The number to call to request an enrollment packet is 217-782-0538.

Multiple Providers

• Providers may specify more than one change within the request when all of those changes relate to the same billing NPI. Examples of those changes may include multiple-billing NPIs or multiple providers within a group that must request a spreadsheet rather than on the on line form. The changes are not immediate, as some processing may take up to 15 business days.