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NPI: Reminder: Use the NPI for All Claims and TARs Update

November 4, 2008

Effective for dates of service on or after October 1, 2008, the Department of Health Care Services (DHCS) is only accepting the National Provider Identifier (NPI) on all Medi-Cal and Child Health and Disability Prevention (CHDP) program claims. The only exceptions to this requirement for claims are “atypical” providers such as Blood Banks, Christian Science Practitioners and Multipurpose Senior Services Program providers that will continue to use Medi-Cal legacy provider numbers.

Medi-Cal providers currently in the process of transitioning to the NPI may still have claims processed using the legacy number, but they must register their NPI with Medi-Cal and begin using it for all transactions immediately.

If a Medi-Cal legacy number has already been end-dated because of a successful NPI claim submission or the NPI transition deadline of October 1, 2008, claims must be billed using the registered NPI.

Effective November 1, 2008, Medi-Cal providers must use their registered NPI on all TARs. NPIs registered with the DHCS Provider Enrollment Division (PED) can be used for all past and future dates of service. Providers were notified in the September Medi-Cal Update that all Medi-Cal legacy numbers would be end-dated effective October 1, 2008. As a result, the TAR system can no longer accept legacy numbers and will be rejected effective November 1, 2008. Therefore, TARs submitted with a legacy number will not be processed.

Providers should submit TARs using the NPI for dates of service rendered pre- and/or post-NPI implementation. Medi-Cal field offices and Pharmacy sections will continue to correct TARs authorized with a legacy number until November 1, 2008, if providers receive a claim denial due to a NPI/legacy number mismatch.

Note:

Providers must register their NPI in order for it to be successful for TARs and claims.

Providers can contact the Telephone Service Center (TSC) at 1-800-541-5555 to verify that their legacy numbers are properly cross-referenced to their NPI(s). After verifying that the cross-reference of legacy numbers to one or multiple NPIs is accurate, providers may need to update their NPI registration. To do so, providers should submit a Medi-Cal Supplemental Changes Form (DHCS 6209) to PED so the most current information will be on record.

For example, if a provider registers a different NPI or adds another NPI, the cross-referencing system may not contain any of the prior legacy number information required to link the claim to the TAR for accurate processing. Any NPI registration that is not current may result in claims being denied or rejected.

Secondary Provider Identifiers
In accordance with the NPI final rule, all secondary provider identifiers must be an NPI. When Medi-Cal providers fill out the secondary provider identifier fields on a claim, the billing provider should attempt to use the NPI of all secondary providers such as rendering, referring, or prescribing providers. Providers can obtain NPI information by reviewing the NPI Registry on the National Plan and Provider Enumeration (NPPES) Web site or contacting the secondary provider directly.

If all attempts to acquire the NPI for a secondary provider are not successful, providers should follow these instructions:

  • The group provider’s NPI must be entered into the Billing Provider field.
  • The legacy number may be used for the Rendering Provider fields.
  • The legacy and/or license numbers may be used for the Attending, Admitting, Operating, Referring and/or Prescribing provider fields.

Medi-Cal will only allow the use of legacy and/or license numbers in the claim form fields identified above while providers transition to the sole use of the NPI. The complete implementation of the NPI for secondary providers will be announced in a future Medi-Cal Update.

Crossover Claims
The NPI used to bill Medicare must be registered with Medi-Cal in order for the claim to cross over automatically or the claim will not be processed. If Medicare rejects a provider’s claims for not using the NPI, the provider must resubmit the claim to Medicare. Medicare must process the claim before Medi-Cal can reimburse the crossover claim.

The TSC is available at 1-800-541-5555 to assist with NPI registration. Select language preference (option 11 for English; option 12 for Spanish), then select option 16, then option 18.



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