What identifies providers in standard transactions involving health care claims?

The National Provider Identifier (NPI) is essential in standard transactions involving health care claims because it serves as a unique identification number for health care providers. The NPI is a 10-digit number that is assigned to all health care providers in the United States by the Centers for Medicare & Medicaid Services (CMS). It is used to ensure that providers are properly identified when submitting claims to insurance companies, payers, and health care systems.

Utilizing the NPI helps streamline the billing process and enhances the efficiency of healthcare transactions. Providers use this number to establish their identity and to facilitate the sharing of medical information across various platforms within the health care system.

In contrast, state license credentials are specific to individual states and do not universally identify providers across different regions or systems. CPT (Current Procedural Terminology) codes and ICD (International Classification of Diseases) numbers serve different purposes; CPT codes describe medical procedures and services, while ICD numbers are used for diagnosing and coding health conditions. Neither of these options provides a universal identifier for the provider engaging in the transaction.