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NPI: NPI and Legacy Number Billing Guidelines for Deactivated Providers

March 7, 2008

On September 21, 2007, the Department of Health Care Services (DHCS) conducted a mass deactivation of providers who had not submitted a claim or received reimbursement within the previous 12-month period.

When the National Provider Identifier (NPI) “dual use” period ended on December 17, 2007, NPI records were created only for providers with active status. Therefore, NPI records were not created for providers who had registered their NPI and had been deactivated as of that date.

This means that deactivated providers will not be able to use the NPI in billing, communication and/or any transactions with Medi-Cal regardless of the NPI registration made prior to their deactivation. Providers submitting claims for dates of service prior to their deactivation must use their old Medi-Cal “legacy” provider number. Checkwrite information for these claims will reflect the provider’s legacy number.

Additionally, for claims submitted with the legacy provider number and processed through Erroneous Payment Corrections (EPCs), the legacy provider number will be reflected on the checkwrite.

Providers wishing to be reactivated must complete the appropriate Medi-Cal enrollment application and submit it to the DHCS Provider Enrollment Division. Enrollment application forms are available on the Provider Enrollment Division (PED) page of the Medi-Cal Web site. Providers may also call the Telephone Service Center (TSC) at 1-800-541-5555 to obtain an application.

Except for atypical providers, an NPI must be identified on the enrollment application.



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