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National Provider Identifier

This identifier is a requirement of the Health Insurance Portability and Accountability Act (HIPAA) and must be used by health care providers including clinical social workers, health plans, health care clearinghouses, and other covered entities that conduct electronic transactions. Clinical social workers must use only their NPIs to identify themselves in standard transactions such as claims, eligibility inquiries and responses, claim status inquiries and responses, referrals, and remittance advices.

The NPI will replace current provider identifiers used by clinical social workers and eliminate the need for them to use different identification numbers to identify themselves when conducting standard transactions with multiple health plans. More information about the NPI can be found in the NASW’s Practice Update, "The National Provider Identifier and the Clinical Social Worker" at https://www.socialworkers.org/ldf/legal_issue/2007/200705.asp

Clinical social workers should be aware of the following:

  • Although you may receive notices about the NPI from third-party payers that you conduct business with, you only need to apply for an NPI once.

  • Applying for an NPI does not replace enrollment or credentialing processes with any third-party payer.

  • Health plans might request that you begin using your NPI prior to the compliance date.

Application

Clinical social workers may apply for the NPI in the following ways:

  • Electronic applications are available at https://nppes.cms.hhs.gov

  • You may prepare a paper application and submit it to the NPI Enumerator. The application is available at https://nppes.cms.hhs.gov. You may also call the Enumerator for an application at 1-800-465-3203 or TTY 1-800-692-2326.

  • An employer, with your permission, may submit your application in an electronic file containing your information and the information of other health care providers.

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11/24/2014

National Association of Social Workers - Massachusetts Chapter
14 Beacon Street, Suite 409, Boston MA 02108
tel: (617)227-9635 fax: (617)227-9877 email: chapter@naswma.org
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