Molina worked diligently and collaboratively to achieve compliance with the HIPAA NPI requirements. Beginning May 23, 2008, in order to comply with the HIPAA regulations HIPAA standard transactions must include NPIs No legacy identifiers (other then the billing/pay-to provider's Tax ID number) may be included on HIPAA standard transactions as of May 23, 2008. Non compliant transactions will be rejected by Molina.
The HIPAA standard transactions conducted by providers are:
- 837 Claim
- 270/271 Eligibility Inquiry/Response
- 276/277 Claim Status Inquiry/Response
- 278 Service Request/Response
- 835 Remittance Advice
NPI Overview
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Secretary of Health and Human Services (HHS) was required to adopt a national standard unique identifier for covered health care providers. On January 23, 2004 the Secretary published the 
Final Rule that adopted the National Provider Identifier (NPI ) as the standard unique identifier. The Centers for Medicare and Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to identify providers and assign NPIs.
The NPI is a ten-digit number and must be used on HIPAA standard electronic transactions, such as claims, to identify a provider. Starting May 23, 2005, all health care providers can apply for their National Provider Identifier (NPI). Health care providers and most health plans must comply with the NPI Rule by May 23, 2007.
Click here to see which electronic transactions covered under HIPAA that providers conduct with Molina must use the NPI.
How to Apply for your NPI
Providers may apply on-line at the NPPES web site.
Information Required to Obtain your NPI
For Providers who are Individuals:
| Provider Name |
Provider Date of Birth |
| Provider Gender |
State of Birth (if Country of Birth is U.S.) |
| Country of Birth |
SSN or other proof of identity |
| Mailing Address |
Practice Location Address and Phone Number Taxonomy (Provider Type) State License Information * |
| Contact Person Name |
Contact Person Phone Number and E-mail |
* (required for certain taxonomies only)
Note: Taxonomy codes describe provider type/classification/specialization of Individual and Organization health care providers. A complete list of taxonomy codes is available from the Washington Publishing Company.
Providers (Type 1) who will be required to obtain an NPI include physicians, non-physician healthcare practitioners, other suppliers and certified providers such as institutions, home health agencies and skilled nursing facilities. Each individual practitioner will receive one NPI. However, an organizational provider (Type 2) may obtain an NPI for each of its subparts.
A subpart can be considered a separate physical location of an organization health care provider, member of a chain or an organization health care provider separately licensed or certified. Review the information below to determine if you need to obtain NPI's for subparts.
Overview
Subparts
Fact Sheet
Decision Tree for Determining NPI Subparts
NPI Educational Resources and Tips
CMS has developed a variety of educational resources to help providers obtain and use their NPI. Click to access CMS's NPI educational resources.
NPI Educational Resources and Tips
Molina has formed an NPI Project Team to implement the NPI. We will publish our NPI transition plan once it becomes available. Please contact Molina's HIPAA Program Office or call our HIPAA Provider Hotline at 1-866-MOLINA2 (1-866-665-4622) if you need more information on our NPI implementation efforts.
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