July 13, 2017

CMS Upgrades National Plan and Provider Enumeration System

By Rick Meeske, Senior, Advisory Services

CMS Upgrades National Plan and Provider Enumeration System

In an effort to increase security and functionality, CMS has made upgrades to the National Plan and Provider Enumeration System (NPPES). As you probably know, the NPPES allows health care providers the ability to apply for, create and manage their National Provider Identifier (NPI) account.

NPI’s are issued to health care providers and are split in to two separate categories, Type 1 Providers and Type 2 Providers. Type 1 Providers are individual providers such as physicians, dentists and other sole providers who are only eligible for one NPI, whereas Type 2 Providers are organizational providers such as hospitals, physician groups, nursing homes, etc.

CMS believes that prior to the upgrade in the NPPES, there was greater opportunity for fraud and identity theft among providers, due to sharing of login information. To combat the issue as well as create better functionality within the system, CMS has added the following features to the new NPPES 3.0:

  • For both types of providers, all users will need to have their own Identity & Access (I&A) authentication credentials in order to access the NPPES. For a provider to apply for this information, they must go to https://nppes.cms.hhs.gov/IAWeb/login.do.
  • Once a user gets their I&A information, they are able to login into NPPES and have access to the NPI’s that are linked to that account. This will create better functionality for Type 2 providers with multiple facilities.
  • When entering information into the system, any unnecessary data will be filtered out by the new smart filters that will show only the information that the user enters.
  • The smart filter will also allow all taxonomy information to be entered onto one page.
  • NPPES 3.0 now offers a help option, located on the user’s current work-screen, which will allow the user to ask questions while working on their screen, and not force them to leave that page.
  • The upgrade will also allow users who are set up as administrators to enter information for the providers, assuming they are credentialed under that provider’s NPI.
  • NPPES 3.0 has also added new entry fields within the system that will allow the user to add more information. Users will now be able to enter race and ethnicity, provider office hours of operation, provider’s direct email as well as primary and secondary languages.

As providers have been able to do in the past, they will be able to submit multiple NPI applications using Comma Separated Values (CSV) files within the Electronic File Interchange (EFI). Access to the EFI will need to be applied for by the users, which can be done by logging into the NPPES and clicking on the Manage EFI button on the bottom of the homepage.

If you have any questions about the new NPPES 3.0 upgrade, read answers to frequently asked questions.

If you have any further questions, please contact your Marcum advisor.

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