March 5, 2007

Effective May 23, 2007, applicants and providers will be required to submit their National Provider Identifier (NPI) with each Medi-Cal provider application package. Current Medi-Cal providers will be required to submit both the NPI and any Medi-Cal provider numbers issued previously on any application forms submitted to the California Department of Health Services (DHCS).

In accordance with Centers for Medicare & Medicaid Services (CMS) requirements, DHCS is revising all provider enrollment application forms to accommodate the NPI. Implementation of the NPI by May 23, 2007 is a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Information in this article is effective May 23, 2007, and published based on the authority granted by Welfare and Institutions Code (W&I Code), Section 14043.75(b).

Note:

This article is published while DHCS considers how to further implement CMS HIPAA requirements. DHCS may address additional changes through future Medi-Cal Updates.

In addition to revisions made to implement the NPI, a section was added to the provider agreement, incorporating Section 6032 of the federal Deficit Reduction Act of 2005. These requirements were published in the December 2006 Medi-Cal Update and were effective January 1, 2007.

Procedures and Requirements
Applicants must submit their NPI with the appropriate revised application forms listed below to enroll as a Medi-Cal provider. If providers are not eligible to receive an NPI, they are not required to submit an NPI and should instead enter the word “atypical” in the NPI field. These “atypical providers” receive a unique Medi-Cal provider number once the application is approved.

Applicants with more than one NPI must submit the additional NPIs registered with Medicare or other carriers to ensure proper payment of crossover claims.

The revised forms listed below are required for all application and disclosure packages received by DHCS on or after May 23, 2007. Application and disclosure packages received before May 23, 2007 are processed under the rules and regulations in effect at the time of receipt. The NPI, if available, should be written on those forms. DHCS provider enrollment staff will contact applicants to obtain verification of the NPI numbers.

All references to the forms below inCalifornia Code of Regulations (CCR), Title 22, Division 3, are amended to refer to the March 2007 version:

• Medi-Cal Durable Medical Equipment Provider Application (DHS 6201)
• Medi-Cal Orthotics And Prosthetics Provider Application (DHS 6202)
• Medi-Cal Provider Group Application (DHS 6203)
• Medi-Cal Provider Application (DHS 6204)
• Medi-Cal Pharmacy Provider Application (DHS 6205)
• Medi-Cal Medical Transportation Provider Application (DHS 6206)
• Medi-Cal Disclosure Statement (DHS 6207)
• Medi-Cal Provider Agreement (DHS 6208)
• Medi-Cal Supplemental Changes (DHS 6209)
• Medi-Cal Physician Application/Agreement (DHS 6210)
• Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement For Physician/ Allied/Dental Providers (DHS 6216)
• Successor Liability With Joint and Several Liability Agreement (DHS 6217)
• Medi-Cal Nonphysician Medical Practitioner And Licensed Midwife Application (DHS 6248)

Valid NPI Verification
Applicants must submit verification of each NPI submitted to DHCS in an application package, including the Medi-Cal Supplemental Changes form, if appropriate. Applicants are required to attach a copy of the CMS/National Plan and Provider Enumeration System (NPPES) confirmation letter for each NPI listed in the application package. DHCS will not process an application package without the valid NPI verification.

Taxonomy Codes
Each applicant must submit all taxonomy codes provided in their original application to CMS/NPPES.