List of Subjects in 45 CFR Part 162
Administrative practice and procedure, Electronic transactions, Health facilities, Health insurance, Hospitals, Incorporation by reference, Medicare, Medicaid, Reporting and recordkeeping reports.
For the reasons set forth in the preamble, 45 CFR subchapter C part 162 is amended as follows:
PART 162-ADMINISTRATIVE REQUIREMENTS
1. The authority citation continues to read as follows:
Authority: Secs. 1171 through 1179 of the Social Security Act (42 U.S.C. 1320d-1320d- 8), as added by sec. 262 of Pub. L. 104-191, 110 Stat. 2021-2031, and sec. 264 of Pub. L. 104-191, 110 Stat. 2033-2034 (42 U.S.C. 1320d-2 (note)).
2. A new subpart D is added to read as follows:
Subpart D-Standard Unique Health Identifier for Health Care Providers
Sec.
162.402 Definitions.
162.404 Compliance dates of the implementation of the standard unique health identifier for health care providers.
162.406 Standard unique health identifier for health care providers.
162.408 National Provider System.
162.410 Implementation specifications: Health care providers.
162.412 Implementation specifications: Health plans.
162.414 Implementation specifications: Health care clearinghouses.
Subpart D-Standard Unique Health Identifier for Health Care Providers
§ 162.402 Definitions.
Covered health care provider means a health care provider that meets the definition at paragraph (3) of the definition of ''covered entity'' at§ 160.103 of this subchapter.
§ 162.404 Compliance dates of the implementation of the standard unique health identifier for health care providers.
(a) Health care providers. A covered health care provider must comply with the implementation specifications in§ 162.410 no later than May 23, 2007.
(b) Health plans. A health plan must comply with the implementation specifications in § 162.412 no later than one of the following dates:
(1) A health plan that is not a small health plan-May 23, 2007.
(2) A small health plan-May 23, 2008.
(c) Health care clearinghouses. A health care clearinghouse must comply with the implementation specifications in § 162.414 no later than May 23, 2007.
§ 162.406 Standard unique health identifier
for health care providers.
(a) Standard. The standard unique health identifier for health care providers is the National Provider Identifier (NPI). The NPI is a 10-position numeric identifier, with a check digit in the 10th position, and no intelligence about the health care provider in the number.
(b) Required and permitted uses for the NPI.
(1) The NPI must be used as stated in§ 162.410, § 162.412, and § 162.414.
(2) The NPI may be used for any other lawful purpose.
§ 162.408 National Provider System.
National Provider System. The National Provider System (NPS) shall do the following:
(a) Assign a single, unique NPI to a health care provider, provided that-
(1) The NPS may assign an NPI to a subpart of a health care provider in accordance with paragraph (g); and
(2) The Secretary has sufficient information to permit the assignment to be made.
(b) Collect and maintain information about each health care provider that has been assigned an NPI and perform tasks necessary to update that information.
(c) If appropriate, deactivate an NPI upon receipt of appropriate information concerning the dissolution of the health care provider that is an organization, the death of the health care provider who is an individual, or other circumstances justifying deactivation.
(d) If appropriate, reactivate a deactivated NPI upon receipt of appropriate information.
(e) Not assign a deactivated NPI to any other health care provider.
(f) Disseminate NPS information upon approved requests.
(g) Assign an NPI to a subpart of a health care provider on request if the identifying data for the subpart are unique.
§ 162.410 Implementation specifications: Health care providers.
(a) A covered entity that is a covered health care provider must:
(1) Obtain, by application if necessary, an NPI from the National Provider System (NPS) for itself or for any subpart of the covered entity that would be a covered health care provider if it were a separate legal entity. A covered entity may obtain an NPI for any other subpart that qualifies for the assignment of an NPI.
(2) Use the NPI it obtained from the NPS to identify itself on all standard transactions that it conducts where its health care provider identifier is required.
(3) Disclose its NPI, when requested, to any entity that needs the NPI to identify that covered health care provider in a standard transaction.
(4) Communicate to the NPS any changes in its required data elements in the NPS within 30 days of the change.
(5) If it uses one or more business associates to conduct standard transactions on its behalf, require its business associate(s) to use its NPI and other NPIs appropriately as required by the transactions that the business associate(s) conducts on its behalf.
(6) If it has been assigned NPIs for one or more subparts, comply with the requirements of paragraphs (a)(2) through (a)(5) of this section with respect to each of those NPIs.
(b) A health care provider that is not a covered entity may obtain, by application if necessary, an NPI from the NPS.
§ 162.412 Implementation specifications: Health plans.
(a) A health plan must use the NPI of any health care provider (or subpart(s), if applicable) that has been assigned an NPI to identify that health care provider on all standard transactions where that health care provider's identifier is required.
(b) A health plan may not require a health care provider that has been assigned an NPI to obtain an additional NPI.
§ 162.414 Implementation specifications: Health care clearinghouses.
A health care clearinghouse must use the NPI of any health care provider (or subpart(s), if applicable) that has been assigned an NPI to identify that health care provider on all standard transactions where that health care provider's identifier is required.
Subpart F-Standard Unique Employer Identifier
3. In § 162.610, paragraph (c) is added to read as follows:
§ 162.610 Implementation specifications for covered entities.
* * * * *
(c) Required and permitted uses for the Employer Identifier.
(1) The Employer Identifier must be used as stated in § 162.610(b).
(2) The Employer Identifier may be used for any other lawful purpose.
Authority: Secs. 1171 through 1179 of the Social Security Act (42 U.S.C. 1320d-1320d-8), as added by sec. 262 of Pub. L. 104-191, 110 Stat. 2021-2031, and sec. 264 of Pub. L. 104-191, 110 Stat. 2033-2034 (42 U.S.C. 1320d-2 (note)).
(Catalog of Federal Domestic Assistance Program No. 93.774, Medicare-Supplementary Medical Insurance Program.)
Dated: October 16, 2003.
Tommy G. Thompson,
Secretary.
[FR Doc. 04-1149 Filed 1-22-04; 8:45 am]
BILLING CODE 4120-01-P