Standard Unique Health Identifier for Healthcare Providers

II. Provisions of the Regulations and Discussion of Public Comments

Within each section of this final rule, we set forth the proposed provision contained in the May 7, 1998, proposed rule, summarize and respond (if appropriate) to the comments we received on the proposed provision, and present the final provision.

It should be noted that the proposed rule contained multiple proposed ‘‘requirements.’’ In this final rule, we replace the term ‘‘requirement’’ with the term ‘‘implementation specification,’’ where appropriate. We do this to maintain consistency with the use of those terms as they appear in the statute and the other published HIPAA rules. Within the comment and response portion of this final rule, for purposes of continuity, however, we use the term ‘‘requirement’’ when we are referring specifically to matters from the proposed rule. In all other instances, we use the term ‘‘implementation specification.’’

In the May 7, 1998, proposed rule, we proposed a standard unique health identifier for healthcare providers. We listed the kinds of identifying information that would be collected about each healthcare provider in order to assign the identifier.

In addition to the requirement that healthcare providers use the standard, the May 7, 1998, proposed rule also proposed other requirements for healthcare providers:

• Each healthcare provider must obtain, by application if necessary, an NPI.
  
• Each healthcare provider must accept and transmit NPIs whenever required on all standard transactions it accepts or transmits electronically.
  
• Each healthcare provider must communicate to the National Provider System (NPS) any changes to the data elements in its record in the NPS within 60 days of the change.
  
• Each healthcare provider may receive and use only one NPI. An NPI is inactivated upon death or dissolution of the healthcare provider.

A. General Provisions

1. Applicability

The May 7, 1998, proposed rule for the standard unique health identifier for healthcare providers discussed the applicability of HIPAA to covered entities. The proposed rule provided that section 262 (Administrative Simplification) of HIPAA applies to health plans, healthcare clearinghouses, and healthcare providers when healthcare providers electronically transmit any of the transactions to which section 1173(a)(1) of the Act refers. Comments received with respect to Applicability are discussed in sections II. A. 2., ‘‘Definition of healthcare Provider,’’ and II. A. 5., ‘‘Implementation Specifications for healthcare Providers, Health Plans, and healthcare Clearinghouses’’ of this preamble.

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