Modernizing the National Plan and Provider Enumeration System
The Centers for Medicaid and Medicare Services (CMS) seeks to improve the existing National Plan and Provider Enumeration System (NPPES) to improve usability, scalability and data quality. APPLY NOW
NPPES is the national enumeration system responsible for assigning the National Provider Identifier (NPI) as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The NPI is the unique identifier for healthcare providers and facilitates electronic transactions including eligibility and claims status inquiries and responses, referrals, remittance advices, etc. Currently over 4 million NPIs have been assigned to health care providers and over 4.3 million changes have been accepted to their records in NPPES. The use of the NPI has significantly increased. On average more than 2,000 users download the publicly available file monthly and 2,000 to 10,000 users access the system on a daily basis. Now, more than ever the NPI is being analyzed by the health industry for additional uses, prompting more data requests from the industry.
The purpose of this project is to upgrade and improve the quality of data collected and stored in NPPES by identifying options for innovative and cost effective methods to verify self-reported data using internal and external sources, such as: 1) checks against Internal Revenue Service tax identification numbers; 2) medical licensure information from State medical boards; and 3) geographical data to validate the address of health care providers. In addition, CMS seeks to reduce the number of manual processes required to maintain NPPES by implementing features such as electronic signature and digital documents.
Skill Sets for the External Entrepreneur
- Information technology (IT) innovator
- Understands Software Development Life Cycle (SDLC)
- Experience in developing a strategic approach for creating IT products
- Excellent data analysis skills
- Knowledge of healthcare data and experience in health information technology is preferred
- Peter Budetti, Deputy Administrator for Program Integrity, CMS
- Zabeen Chong, Director, Provider Enrollment Operations Group, CMS