NPI Validation Profile Overview

EDI files contain the following minimum information on Providers: a name, a qualifier, and a National Provider Identifier (NPI). An NPI is a unique 10-digit number that identifies a Provider as registered with the NPI government registry. This profile represents a mechanism to validate Providers' NPIs using the external open-source service NPPES NPI Registry through the REST API.

Profile Location

Edifecs Library / Best Practices / Business Cases / NPI Validation

Requirements

  • Edifecs XEngine 8.8.1 or later
  • Edifecs XEServer 8.8.1 or later
  • Edifecs Application Manager (EAM) 8.8.1 or later
  • HIPAA Standards 8.8.1 or later

The Provider's NPI is registered with the NPPES NPI Registry.

  1. In Edifecs Application Manager, add the profile NPI Validation from the Edifecs Library to XESever. For more information, see Edifecs Library Help Center.
  2. Go to ${XESProfile}\bin and run start.bat to start the profile.
  3. Copy the sample file 837P_rightNPI.dat from the folder ${XESProfileConfig}\configuration\testdata to the directory ${XESWorkspace}\test-data\inbound.
  4. Go to the directory ${XESWorkspace}\test-data\outbound\valid. The JSON-formatted response with details on the Provider stored in this folder indicates that the Provider is registered with the NPPES NPI Registry.

The Provider's NPI is not registered with the NPPES NPI Registry.

  1. Copy the sample file 837P_wrongNPI.dat from the directory ${XESProfileConfig}\configuration\testdata\ to the directory ${XESWorkspace}\test-data\inbound.
  2. Go to the directory ${XESWorkspace}\test-data\outbound\. The directory ${XESWorkspace}\test-data\outbound\not valid is created. The directory contains the following JSON-formatted response:

{"result_count":0, "results":[]}

This means that no Provider was retrieved from the NPPES NPI Registry during the route processing.