What's New

May 1, 2008

Medi-Cal does not require providers to obtain separate National Provider Identifiers (NPIs) for the different programs administered by the Department of Health Care Services (DHCS) or California Department of Public Health (CDPH). The same NPI obtained for the primary Medi-Cal provider number may be registered with Medi-Cal for providers enrolled in special programs such as Cancer Detection Programs: Every Woman Counts or Family PACT (Family Planning Access, Care and Treatment). Providers must ensure that they register all of their Medi-Cal provider numbers, including those for the special programs.

Additionally, providers are not required to obtain and register a separate NPI for Medi-Cal if they already have obtained an NPI for Medicare for the same types of services. The same NPI obtained for billing to Medicare must be the same NPI registered and used for billing to Medi-Cal. The intent of the NPI regulation is to use only one NPI when billing several payers or programs as opposed to obtaining and registering separate NPIs for each payer, program and/or location.

Providers who have elected to enumerate at a payer, program and/or location level and use different NPIs to bill for the same types of services, may want to reconsider their enumeration strategy. The next iteration of the Transaction and Code Set standard slated to become regulation (version 5010), requires providers to use one NPI for the same types of services billed to all payers as opposed to being optional in the 4010A1 version. This means that providers who have elected to enumerate differently from payer to payer will be required to make changes when Medi-Cal implements version 5010. It is in the provider’s best interest to assess this now and not wait until this becomes mandated.

Currently, this particularly affects providers who bill for Medicare/Medi-Cal or dual-eligible beneficiaries. If the NPI used to bill Medicare is not the same as the one used to bill Medi-Cal, the claims cannot successfully cross over electronically from the Coordination of Benefits Contractor. As a result, providers must then submit hard copy claims to receive reimbursement.