| National Provider Identifier
Submission Form - Page 1 |
| The National Provider Identifier (NPI) is an
administrative simplification mandate of HIPAA that requires every health-care
provider to obtain and use a unique 10-digit identifier (NPI) by May 23, 2008.
This identifier will replace all current health-care provider numbers used in
HIPAA standard transactions, such as electronic claims submissions. Please
refer to the
CMS web site for additional information or Click here to access the CMS website to Apply Online for an NPI.
After you obtain your NPI from CMS, please use this tool to submit your
NPI to
AmeriHealth Mercy Health Plan
.
|
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| Instructions:
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| Submit your NPI
to
AmeriHealth Mercy Health Plan
with this easy to use on-line tool or
click here to print a form to mail or fax to us. |
|
| Step 1. Basic
Identifying Information. Complete this section with information on
your organization and how we can get in touch with you if we have questions
about the NPI information you have submitted. |
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| Step 2.
Practice/Facility Information (Type 2 NPI). Enter the NPI and
related information on your practice and/or facility. This is referred to as
your Type 2 or Organizational NPI. Also, please submit NPIs for all subparts
within your organization for which you intend to submit claims, or for each of
the subparts in your organization that have payer identification number with
us. (e.g. radiology, labs, etc.) However, Type 2 entities that do not have
subparts can skip Step 3 and may complete their submission from this point by
clicking the "Finish without submitting Type 1 NPI" button. |
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| Step 3. Individual Provider NPIs (Type 1
NPI). Enter the NPI and related information for each of the
providers in your organization who have a payer identification number with us. |