March 10, 2008

The Medi-Cal provider identifier “dual-use" period ended in December 2007. However, the transactions listed below have been exceptions to the dual-use period, because they are transactions where both sets of provider identifiers (Medi-Cal/CHDP provider numbers and National Provider Identifiers [NPIs]) were not supported. For such cases, providers were instructed to continue using the Medi-Cal/CHDP provider “legacy” number beyond the December 17, 2007 NPI implementation date.

The POS Network applications and transactions listed below can now accept the NPI.
Modifications have been made to the following:

• POS device software
• Internet software
• Mainframe supportive software

Real-time processing transactions included are:

• Internet transactions
• Point of Service (POS)
• Automated Eligibility Verification System (AEVS)
• Supplemental Automated Eligibility Verification System (SAEVS)

Note:

Providers defined by the HIPAA final rule and Medi-Cal/CHDP policy as “atypical” will continue to use only their nine-digit Medi-Cal/CHDP provider numbers.

POS Device Download
Beginning August 25, 2007, messages appeared on POS devices announcing an automatic software update download. This software update accommodated the 10-digit NPI in preparation for Medi-Cal’s implementation. Providers may now enter the NPI in transactions submitted on POS devices.

Eligibility
For eligibility transactions, Medi-Services reservations and Share of Cost (SOC) spend down, dial-up or leased-line transmissions, providers may now enter their NPI. Information about sending and receiving data via leased-line and dial-up submissions is available in the ASC X12N 270/271 Version 4010A1 Health Care Eligibility Benefit Inquiry and Response (Real-Time and Batch) companion guide.

Providers can download the 270/271 Overview for Leased-Line, Dial-Up and Batch Submissions section of the guide. Information about mandatory testing for the 270/271 v.4010A1 eligibility transaction using the NPI is in that section.

Note:

Providers who tested 270/271 v.4010A1 eligibility transactions using their Medi-Cal/CHDP provider numbers do not need to retest using NPI numbers.

Test NPI-Only NOW
Providers who have been submitting claims successfully during the “dual-use period” with both an NPI and a Medi-Cal legacy provider number are strongly recommended to test the new NPI-only claims process by initially submitting only one or two claims. If these claims are processed successfully, providers are then strongly urged to submit all subsequent claims using only the NPI. The absolute end-dating of the Medi-Cal legacy numbers is May 23, 2008.

Pharmacy
The dual-use period is not ending at this time for Pharmacy providers billing on the Medi-Cal Pharmacy claim forms (30-1 and 30-4) or conducting NCPDP transactions. Pharmacy providers can continue to submit claims and NCPDP transactions with either the NPI or Medi-Cal Provider number. Providers will be notified in a future bulletin the end date for the dual-use period for these claims.

The dual-use period ended in December 2007 for all Pharmacy claims billed on the CMS-1500 form (medical supplies claims).