National Provider Identifier (NPI)
Definition
The National Provider Identifier (NPI) is a unique 10-digit identification number assigned to covered health care providers under HIPAA. It is used in administrative and financial transactions—including Medicaid billing, Medicare claims, and other health care transactions—to identify the provider associated with a service.
In the 340B context, NPIs are used in several ways: covered entities include their NPI (and/or state Medicaid number) in OPAIS as part of their Medicaid billing designation; contract pharmacies use their NPIs in claims submission; and prescriber NPIs are used in split-billing software to identify whether a prescription was written by a provider employed by or under contract with the covered entity.
Accurate NPI management is important for both Medicaid billing compliance and patient eligibility determination. Incorrect or outdated NPI information in OPAIS or split-billing software can create billing errors and eligibility determination failures.
Frequently Asked Questions
Why National Provider Identifier (NPI) Matters
NPIs are used in multiple aspects of 340B program administration, including Medicaid billing and patient eligibility determination. Accurate NPI management is a basic compliance requirement.
How Virtue 340B Uses It
Virtue 340B reviews NPI accuracy in OPAIS and split-billing software configurations as part of our audit and monitoring services.