MLN Matters Number: MM6036
Related Change Request (CR) #: 6036
Related CR Release Date: July 25, 2008
Effective Date: May 23, 2008
Related CR Transmittal #: R263PI
Implementation Date: August 8, 2008
Provider Types Affected
Providers and suppliers submitting claims to Medicare contractors (carriers, fiscal intermediaries (FIs), Part A/B Medicare Administrative Contractors (A/B MACs and DME MACs) for services provided to Medicare beneficiaries.
Provider Action Needed
This article is informational only and is based on Change Request (CR) 6036 which reminds providers that the Centers for Medicare & Medicaid Services (CMS) no longer issues, updates, or uses the Unique Physician Identification Number (UPIN) in claims processing. CR 6036 also provides information on how to access the National Plan and Provider Enumeration System (NPPES) and UPIN data.
Background
The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandate the adoption of a standard unique health identifier for each health care provider. CMS published the National Provider Identifier (NPI) final rule, which established the NPI as this standard.
CR 6036 updates Medicare’s Program Integrity Manual, Chapter 14, Sections 14.1 -14.4) by removing information related to the issuance and maintenance of UPINs and replacing this information with information about obtaining NPI and UPIN data. CR 6036 includes the updated Chapter 14 as an attachment.
Information about the NPI can be found on the National Provider Identifier Standard Web page at www.cms.hhs.gov/NationalProvIdentStand/.
Since the UPIN Registry is no longer available, a copy of the UPIN file can be obtained by writing to:
CMS Public Use Files
7500 Security Boulevard, N1-15-03
Baltimore, MD 21244-1850
The following information is releasable for physicians and non-physician practitioners:
- Full name,
- Credentials (e.g., MD),
- UPIN,
- State,
- ZIP Code, and
- Specialty code.
Additional Information
The official instruction, CR 6036, issued to your carrier, FI, A/B MAC, and DME MAC regarding this change may be viewed at
www.cms.hhs.gov/Transmittals/downloads/R263PI.pdf (PDF, 329 KB).
If you have questions, please contact our Provider Contact Center at our toll free number at (866) 332-7025 for Ohio and West Virginia or (888) 828-2092 for South Carolina.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.