This category includes general questions about the National Provider Identifier (NPI), atypical providers, provider enrollment, taxonomy and subparts.

For additional questions regarding NPI, contact the Telephone Service Center (TSC) at 1-800-541-5555, select language preference (option 11 for English; option 12 for Spanish), select option 16 from the main menu, then select option 18 from the submenu.

A. NPI

1. What is a National Provider Identifier (NPI)?
   A: The administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) required the Secretary of Health and Human Services (HHS) to adopt a national standard identifier for health care providers for use in the health care industry. On January 23, 2004, HHS published the NPI final rule that adopts the NPI as the standard unique health identifier for health care providers.
2. How can a provider learn more about NPI?
   A: Visit the NPI area of the Centers for Medi-care & Medicaid Services (CMS) Web site for more information.
3. Has NPI information been published in Medi-Cal Updates?
   A: Yes. NPI information was published in Medi-Cal Updates as early as June 2005. To view previously published articles, visit the Previous Articles page of the NPI area on the Medi-Cal Web site.
4. Does a provider need a separate NPI for Medicare and Medi-Cal?
   A: No. The NPI was established to eliminate having a separate legacy provider number for each health care plan.
5. Does the Department of Health Care Services (DHCS) want to know my NPI information?
   A: Yes. Medi-Cal and Children’s Health and Disability Prevention program providers who have received their NPI from NPPES must register their NPI with DHCS. Providers can register their NPI using one of the following methods:

   • National Provider Identifier Collection (NPIC) tool – The NPIC tool allows NPIs to be registered one at a time, quickly and for free. The online NPI registration tool is available from the Register/Update/Inquire NPIs page.
   • NPI Bulk Registration Tool (BRT) – The BRT is available to providers who would prefer to register multiple NPIs at the same time (mass registration). Instructions are available from the Register/Update/Inquire NPIs page.
   • NPI Paper Registration – The paper registration process using the National Provider Identifier Registration Form is intended for providers who do not have Internet access. Forms can also be obtained by calling the TSC at 1-800-541-5555 and selecting option 16, followed by option 18.
6. Will the NPI replace a provider’s current Medi-Cal number(s)?
   A: Effective December 17, 2007, DHCS started accepting the NPI on claims and transaction services. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise. Atypical providers will continue to use their Medi-Cal provider number.
7. When an organizational provider, such as a county Mental Health Plan has multiple Medi-Cal provider numbers and multiple NPIs, which NPIs should they register with Medi-Cal?
   A: Medi-Cal requires providers to register an NPI with each of their current Medi-Cal provider numbers. If a provider has more Medi-Cal provider numbers than NPIs, then an NPI should be associated with each Medi-Cal provider number to avoid interruption in claim payments. An organization that is not a facility licensed by the California Department of Public Health (CDPH) and has more subpart NPIs to register than existing Medi-Cal or CHDP provider numbers must submit the Medi-Cal Supplemental Changes (DHCS 6209) form to the Provider Enrollment Division (PED). For providers licensed by the CDPH, subpart NPIs may be registered in accordance with the instruction provided in the NPI Registration for Facilities article. Providers enrolled in different Medi-Cal programs, such as Family PACT and Cancer Detection Programs (CDP), are not required to obtain separate NPIs for each program.
8. Do providers have to give their NPIs to doctors nurses, pharmacies etc. that they deal with?
   A: Yes. The CMS and DHCS strongly encourage providers to share their NPI with every entity they work with such as payers and other providers that may need their NPI for billing purposes.
9. When a health care payer, like Medi-Cal, asks for an NPI number, should the provider give the corporation group NPI or the individual NPI?
   A: Medi-Cal requires providers to register both the group and the individual NPI.
10. Are there any restrictions in how NPI numbers are shared between providers?
    A: CMS and DHCS strongly encourage providers to share their NPI with every entity they work with such as payers and other providers that may need their NPI for billing purposes.
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B. Atypical Providers

11. Do all provider types need to apply for an NPI?
    A: In accordance with the NPI final rule, some providers may not qualify for an NPI and therefore are not required to register an NPI with the Medi-Cal program. According to the DHCS interpretation of the final rule, as it relates to “atypical” providers, the following Medi-Cal provider types are not required to register an NPI:

    • Blood Banks
    • Christian Science Practitioner
    • Multipurpose Senior Services Program

    If any of the above provider types acquire an NPI, they may register it with the Medi-Cal program, but it is not required.
12. Are Adult Day Health Care (ADHC) centers "atypical" providers? Will ADHC centers need an NPI in order to bill or can they continue to use their current provider numbers?
    A: DHCS previously interpreted ADHC centers as “atypical” providers and published notices stating that ADHC centers were not required to register an NPI with Medi-Cal or use an NPI on HIPAA-covered transactions. After further evaluation of the ADHC centers' scope of services available under the Medi-Cal benefit structure as they relate to the NPI final rule, DHCS determined that ADHC centers are health care providers. As a result, ADHC centers are now required to apply for an NPI from NPPES, register it with Medi-Cal and use it in HIPAA-covered transactions with Medi-Cal.
13. Why are Christian Science Practitioners not required to register an NPI?
    A: Based on the scope of services provided by Christian Science Practitioners as they relate to the NPI final rule, Medi-Cal has interpreted Christian Science Practitioners to be “atypical" providers and are not required to obtain nor register an NPI. However, if they acquire an NPI, they may register it with the Medi-Cal program, but it is not required.
14. Is there an advantage for "atypical" providers to get an NPI, and should they still register the NPI even though it is not required?
    A: If any of the "atypical" providers (Blood Banks, Christian Science Practitioner, Multipurpose Senior Services Program [MSSP]) acquire an NPI, they may register it with the Medi-Cal program, but it is not required.
15. How will the County Organized Health System (COHS) providers know which providers should continue to bill with Medi-Cal provider numbers because they are considered "atypical" providers and do not qualify for an NPI?
    A: If a provider is identified as a Blood Bank, Christian Science Practitioner, or an MSSP provider they are considered "atypical" providers. These providers will continue to bill the Medi-Cal program using their Medi-Cal provider number (legacy number) even after the implementation of NPI on December 17, 2007.
16. Are Home and Community Based Services Waiver (HCBS) providers (with provider prefixes EPS, RVN, HCB) or pediatric day care providers considered "atypical" providers?
    A: No. Please refer to the first FAQ under the “Atypical Providers” subhead, which lists those providers Medi-Cal has interpreted to be "atypical."
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C. Provider Enrollment

17. How can new providers apply to the Medi-Cal program with an NPI?
    A: Effective May 23, 2007, all applicants and providers are required to submit their NPI with each Medi-Cal provider application package. Current Medi-Cal providers will be required to submit both the NPI and any Medi-Cal provider numbers issued previously on any application form submitted to DHCS. Applicants are required to attach a copy of the CMS NPPES confirmation/verification letter for each NPI listed in the application package. If providers are not eligible to receive an NPI, they should instead enter the word “atypical” in any NPI fields. These “atypical” providers will receive a unique Medi-Cal provider number once the application is approved.
18. When is Medi-Cal going to stop issuing new Medi-Cal provider numbers?
    A: DHCS had stopped the issuance of Medi-Cal provider numbers on February 15, 2008 except for "atypical" providers and pharmacy providers. The following providers are considered “atypical”: Blood Banks, Christian Science Practitioner, Multipurpose Senior Services Program.
19. What happens if a provider’s information (for example, pay-to-address) changes under for their NPI?
    A: Providers are required to update their information in NPPES within 30 days of any changes. Changes such as change in pay-to-address, also needs to be reported to the Provider Enrollment Division (PED) using the appropriate application/form.
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D. Taxonomy and Subparts

20. What is a taxonomy code and how does a provider acquire one?
    A: The Health Care Provider Taxonomy Code (HCPTC) set is an external, non-medical data code set designed for use in classifying health care providers according to provider type or practitioner specialty in an electronic environment, specifically within the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) health care claim transaction. The HCPTC list is a collection of unique alphanumeric codes, 10 characters in length, commonly called “taxonomy codes.” The code set is structured into three distinct levels that include provider type, classification and area of specialization.
    
    The taxonomy codes allow a single provider (individual, group or institution) to identify their areas of specialization. Providers may have one or more areas of specialization. When determining what value or values to associate with a provider, the user needs to review the requirements of the trading partner with which value(s) are being used.
    
    The HCPTC set can be found on the Washington Publishing Company Web site.
21. What are subparts?
    A: Subparts are components of a health care provider organization (i.e. entity type 2) required to be separately enumerated by the NPI rule or who conduct their own HIPAA covered transactions. Health care provider organizations (i.e. entity type 2) also have the discretion to request additional subparts for their organizations. For more information refer to the Subparts page.
22. How does a provider register an NPI for subparts?
    A: In most cases, it is the provider’s choice to register either the same NPI or the subpart (see Subparts) NPI to replace multiple Medi-Cal or CHDP numbers and or locations.
23. What happens if an organizational provider chooses not to subpart?
    A: If a provider chooses to replace multiple Medi-Cal/CHDP provider numbers with one NPI, the various “pay-to” addresses, electronic funds transfer (EFT) accounts and provider identification numbers (PINs) they have for their multiple provider numbers will be transferred to this NPI record. The “pay-to” addresses, EFT account and PIN information on the first Medi-Cal or CHDP number entered in the online registration tool, or designated on the hard copy registration form, will be transferred to the new NPI.
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