NPI: Important NPI Time Frame Changes
Updated August 6, 2007
The Department of Health Care Services (DHCS) has been advised by its Medi-Cal Fiscal Intermediary (F.I.), EDS, that more time is needed to implement and test system changes to ensure correct and timely payment of claims submitted with a National Provider Identifier (NPI). Ensuring timely and accurate payment to Medi-Cal providers is of the utmost priority.
Medi-Cal Provider Number and NPI Dual-Use Period –
May 23, 2007 to November 25, 2007
To maintain payment accuracy and timely payment to
Medi-Cal providers, DHCS will not be implementing all NPI system
changes on May 23, 2007. Instead, DHCS is taking a preliminary
step toward NPI compliance, with what Medi-Cal is referring to
as a “dual-use” period. This will mitigate risk to claims
payment integrity and permit providers to use their NPI on
specified claim transactions and receive an NPI (in addition to
their Medi-Cal provider number) on claim payment responses via
the electronic ANSI ASC X12N 835 transaction and the
Remittance Advice Details (RAD). This dual-use period
begins May 23, 2007.
The dual-use period encourages submission of an NPI along with the Medi-Cal provider number. Use of the Medi-Cal provider number is mandatory. Claims submitted without a Medi-Cal provider number prior to November 26, 2007 will not be accepted for processing. Please note that some exceptions apply where only the Medi-Cal provider number can be received during the dual-use period.
- Electronic pharmacy claims (NCPDP 5.1/1.1 standard)
- All proprietary Medi-Cal forms, including the Payment
Request for Long Term Care form
(25-1), Pharmacy Claim Form (30-1), Compound Drug Pharmacy Claim Form (30-4), Treatment Authorization Request (TAR), Claims Inquiry Form (CIF) and Appeal Form (90-1) - Direct Data Entry (DDE) applications, including Internet Professional Claim Submission (IPCS), Real-Time Internet Pharmacy (RTIP) and the Point of Service (POS) Network
Further information regarding additional exceptions, as well as technical details about dual-use submission, will be available in the "NPI" area of the Medi-Cal Web site.
Claims submitted with only an NPI between May 23, 2007 and November 25, 2007 will not be processed (for crossover claims, see “Medicare Crossover Claims”). DHCS plans to implement NPI system changes allowing only an NPI on November 26, 2007. If only a Medi-Cal provider number is submitted after November 25, 2007, the claim will not be accepted for processing.
Using an NPI and a Medi-Cal provider number during the dual-use period will promote a more successful implementation of NPI. DHCS encourages Medi-Cal providers to migrate away from using a Medi-Cal provider number in their business systems during this time when Medi-Cal provides both sets of identifiers on the ANSI ASC X12N 835 transaction and the paper RAD.
This dual-use period will be a good time for providers to evaluate their business processes and potential needs to request subpart NPI numbers for accounting systems. DHCS recommends that all providers evaluate their subpart determinations during this period and make appropriate updates with Medi-Cal should there be a need for more NPI subparts, or a reduction in the number of subparts currently registered with Medi-Cal. Subpart determination is based on provider choice and should be based on a provider’s business needs.
Register an NPI with Medi-Cal
As a result of this dual-use period, DHCS is extending
the deadline for providers to register their NPI through the
National Provider Identifier Collection (NPIC) online system
from May 23, 2007 to November 25, 2007. The NPIC online system
may be accessed through the
Register, Update or Inquire About NPIs Web page. It is
important that Medi-Cal providers register their NPI as soon as
possible to ensure adequate time for its incorporation into the
Medi-Cal payment system. After registering an NPI, the next
steps toward successful NPI implementation are for providers to
use an NPI in conjunction with their Medi-Cal provider number
and evaluate the impact of their subpart determinations.
Currently, Medi-Cal receives electronic crossover files from the Medicare Coordination of Benefits Contractor (COBC), Group Health Incorporated (GHI), for dual-eligible recipients. These electronic crossovers, commonly referred to as “automatic crossover claims,” are transmitted by the COBC and processed by Medi-Cal without provider intervention. Current automatic crossover processing and payment to the correct Medi-Cal provider number depends on the Medicare legacy provider number included on the claim. Similarly, automatic crossover processing on or after November 26, 2007 will depend on the NPI, or Medicare number if provided by the Medicare Coordination Of Benefits Contractor (COBC). NPI registration with Medi-Cal is required to ensure successful adjudication of Medicare crossover claims received with only an NPI. Only automatic crossover claims containing an NPI registered with Medi-Cal will be processed. Any automatic crossover claims sent to Medi-Cal containing an NPI not registered with Medi-Cal will be rejected as unidentifiable and will not be processed.
Future NPI Instructions
Additional dual-use information about claim forms and
electronic transactions that will support dual-use will be
published in future Medi-Cal Updates. Information about
completing electronic claims, including which fields and
segments to use (Medi-Cal Companion Guides), will also be
released soon.
DHCS encourages all providers to refer to future announcements and to return to the "NPI Overview" page for the latest and most up-to-date information about the NPI dual-use, implementation and claim form transition.