NPI: Important NPI Dual-Use Period Changes
October 5, 2007
In an effort to ensure National Provider Identifier (NPI) implementation success for participating Medi-Cal providers, the Department of Health Care Services (DHCS) is extending the current dual-use period, which began on May 23, 2007, to continue beyond the NPI implementation date. Effective November 26, 2007, the NPI implementation date, a Medi-Cal provider number will continue to be required, even though the NPI is also being requested. Failure to include the Medi-Cal provider number beyond the NPI implementation date could result in delay or denial of payment.
Providing both sets of provider numbers will assist DHCS in its continuing effort to provide prompt and accurate claims payment to Medi-Cal providers. As a result, until post-implementation NPI evaluations occur, use of the Medi-Cal provider number on all transactions will continue to be mandatory to achieve optimal success. Medi-Cal providers must continue using their Medi-Cal provider numbers until instructed otherwise.
The only exception to the dual-use rule is for those transactions where both sets of provider identifiers are not supported, such as the electronic pharmacy claims (NCPDP 5.1/1.1 standard). Where both sets of provider identifiers are not supported, providers must continue to use the Medi-Cal provider number beyond the November 26, 2007 NPI implementation date. Providers defined by the HIPAA final rule and Medi-Cal policy as “atypical” will also continue to use only their Medi-Cal provider numbers.
Please note that the following exceptions apply after the November 26, 2007 implementation date. For these exceptions, only the Medi-Cal provider number can be used during the dual-use period. Below is a partial list:
- 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, 60-1) 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
Register Your NPI
Registration of an NPI is a requisite to payment when the dual-use
period ends. Furthermore, early registration, along with dual-use of an NPI and
Medi-Cal provider identifier, permits DHCS to validate NPI registrations and
prevent delays in payment after the cutover. Providers can register their NPI by
visiting the online NPI registration tool.