The NPI remains with the provider regardless of a job or location change. It does, however, replace all previous identification numbers that providers used for healthcare information transactions, claims, and billing. There are many ways to perform an NPI lookup for a provider or an organization. This is a free service to anyone. You can start with the NPI number or with a name.
The search result includes the NPI number, the first and last name of the provider, the NPI type indicated with icons, primary practice address, phone, and primary taxonomy.
The results are shown in the search result window and can be downloaded , or, even more streamlined and efficient, through an application programming interface API. Tracking actions to a standardized identifier provides transparency that can impede and identify fraud. This is the key to ensuring quality care, quality outcomes, patient safety, and fraud prevention.
Healthcare organizations are legally responsible for assuring that individuals providing patient care are credentialed, verified, and competent to do so. When it comes to provider data, Tracey Tokheim, senior director of product management and enrollment at Verisys, understands the frustrations in keeping provider data accurate in the many places that organizations have it. Tokheim has worked in credentialing, What is an NPI Number? The National Provider Identifier NPI is a standard that establishes a unique health identifier for healthcare providers and entities.
An NPI is a unique identification number created to improve the efficiency and effectiveness of electronic All Blogs. Obtaining an NPI will not :. All healthcare providers or entities such as physicians, suppliers, or hospitals that render healthcare services can obtain an NPI number.
If a provider enrolls in Medicare, they must have an NPI. But, the NPI can be used in many other ways , such as:.
It is designed to ensure quality care because it allows the verification of credentials of a provider who is treating patients or prescribing and ordering equipment and supplies. Keep in mind, however, that having an NPI number does not ensure that a provider is licensed or properly credentialed. Those verifications still need to occur to support patient safety and regulatory compliance.
There are a number of ways NPI numbers can be used fraudulently. Thorough provider screening is the best way to prevent these types of fraudulent actions. It is critical to deactivate the NPI number assigned to a deceased provider, a dissolved entity, or if theft is suspected to further mitigate fraudulent behavior.
Verisys focuses on improving patient safety and elevating the overall quality of healthcare in our country by carefully screening healthcare providers and entities. A large part of our mission is to identify and eliminate excluded providers as well as providers who abuse the healthcare system with fraudulent or unethical behavior.
Because an NPI record is a uniform identification tool for healthcare providers and health plans, it can be a great additional reference for identifying false claims and healthcare fraud. Many healthcare organizations are finding software solutions that integrate and automate workflows for provider verification to help mitigate risk and reduce claim recoupment costs.
For instance, names can be spelled incorrectly, maiden names could not be reflected, or a nickname could be formerly used for a provider or employee. Only using minimal available information for primary source verification can be proven to be faulty given the current government system functionality.
Completing employee and organization profiles with augmented data like NPI and SSN helps create a smarter exclusion monitoring program for your organization to eliminate errors and insufficient information gaps.
Help keep your company safe with the tools you need to more accurately and efficiently search and validate with NPI verification and exclusion screening software. Ready to lookup a provider? Get the latest healthcare news, advice from industry experts, and all things related to monitoring solutions delivered straight to your inbox. Search Contact Us Log In. Contact Us. Log In. Link to Open Side Menu. January 24,
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