A: No. The NPI remains with the provider regardless of job or location changes and will not need to be registered again. However, the provider will need to follow current policy and provide their new location to the Provider Enrollment Division.

A: No. Individual providers must register their NPI under their own Medi-Cal provider number. The organization may register the individual’s NPI on their behalf but they must ensure they use the individual’s Medi-Cal provider number. Providers who do not possess a Medi-Cal provider number to bill the Medi-Cal program directly do not need to register an NPI with Medi-Cal.

A: No. Individual providers are only required to register their NPI with their own Medi-Cal provider number. The clinics must register their own NPIs. If the individual provider has more than one Medi-Cal provider number, they must register each provider number with the NPI obtained from the National Plan and Provider Enumeration System (NPPES).

A: No. Rendering providers working under the group must register their NPI under their current rendering Medi-Cal provider number(s). The rendering providers may authorize someone else to register their NPI on their behalf but they must ensure the individual’s rendering Medi-Cal provider number is used.

A: Yes. An individual must register their one NPI with each of their Medi-Cal provider numbers separately.

A: Yes. A separate NPI needs to be obtained for the group and for each rendering provider in the group even if the group owner is the only physician member of the group.

A: No. The therapist must register their own NPI with their current Medi-Cal provider number. The mental health clinic must also register its own NPI with the clinic’s Medi-Cal provider number. If the therapists do not currently have a Medi-Cal provider number, they may not register their NPI but the clinic must submit their NPI on all electronic HIPAA-standard transactions. In addition to electronic transactions, Medi-Cal is also requiring an NPI on all paper claims.

A: No. In order to register an NPI a provider must have a Medi-Cal provider number. If a provider does not have a Medi-Cal provider number, they may not bill the Medi-Cal program directly so they do not have to register an NPI at this time. However, if the individual provider is a covered entity, as defined by the NPI Rule, the provider must apply for an NPI and their NPI must be included on all claims the school district submits to Medi-Cal for reimbursement.

A: No. In order to register an NPI, a provider must have a Medi-Cal provider number. If a provider does not have a Medi-Cal provider number, they may not bill the Medi-Cal program directly so they do not have to register an NPI at this time. However, if the individual provider is a covered entity, as defined by the NPI Rule, the provider must apply for an NPI and their NPI must be included on all claims the clinic submits to Medi-Cal for reimbursement.

A: No. Providers rendering services in different facilities must register their own NPI using their own Medi-Cal provider number. If a provider does not have a Medi-Cal provider number, they may not bill the Medi-Cal program directly so they do not have to register an NPI at this time. However, if the individual provider is a covered entity, as defined by the NPI Rule, the provider must apply for an NPI and their NPI must be included on all claims submitted to Medi-Cal for their services.

A: Rendering providers must register their own NPI with their individual Medi-Cal provider numbers. NPIs for PAs and any other Non-physician Medical Practitioners (NMPs) that work under the group can be registered under the group or the supervising physician using the NMP NPI Information box. Their license numbers must also be entered.

A: The group is not required to specify their rendering providers to register the group’s NPI. The group must register its own NPI and each rendering provider working under the group must separately register their own NPI. The rendering provider may authorize a representative to register their individual NPI on their behalf but they must ensure the correct NPI is registered to the appropriate Medi-Cal provider number.

A: Yes. A group and its individual owner are required to register each of their NPIs separately.

A: Each facility’s Medi-Cal provider number will need to be registered separately with the one NPI obtained from NPPES.

A: No. The rendering providers will have to register their own separate NPI. Providers rendering services in a hospital who do not have a Medi-Cal provider number do not need to register an NPI. The rendering provider may authorize a representative to register their individual NPI on their behalf but they must ensure the correct NPI is registered to the appropriate Medi-Cal provider number.

A: Yes. The NPI Bulk Registration Tool (BRT) is available for providers to register multiple NPIs at the same time using the National Provider Identifier Collection (NPIC) tool. Specific information about the NPI BRT and technical requirements for file submission may be accessed on the Register, Update or Inquire About NPIs page.

A: Yes. Providers rendering services in a county clinic will need to register their own NPI if they currently have a Medi-Cal provider number. If a provider does not have a Medi-Cal provider number, they may not bill the Medi-Cal program directly so they do not have to register an NPI at this time. However, if the individual provider is a covered entity, as defined by the NPI Rule, the provider must apply for an NPI and their NPI must be included on all claims the clinic submits to Medi-Cal for reimbursement.

A: All providers, including LEA providers, can register using any one of the methods listed below:

• National Provider Identifier Collection (NPIC) Tool – available through the Register, Update or Inquire About NPIs page.
• Bulk Registration Tool (BRT) – available to providers who would prefer to register a large quantity of NPIs at the same time using the NPIC tool. Providers should review the BRT instructions for details and technical requirements on file submission using the mass registration tool.
• Hard Copy NPI 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 Telephone Service Center (TSC) at 1-800-541-5555, select option 16, then select option 18.

A: Only CalOptima providers with a Medi-Cal provider number will need to register their NPI with Medi-Cal unless they are one of the “atypical” providers: blood banks, Christian Science practitioners and Multipurpose Senior Services Programs. CalOptima providers should also contact their CalOptima to determine how they should be sharing their NPI with the plan.

A: Organizations are required to register the Medi-Cal provider numbers for each location under one NPI or several subpart NPIs. Every provider rendering services for the FQHC who has a Medi-Cal provider number will need to register their own NPI. The rendering provider may authorize a representative to register their individual NPI on their behalf but they must ensure the correct NPI is registered to the appropriate Medi-Cal provider number.

A: If a facility has chosen to subpart and has an NPI for each location, each location must register their specific NPI using the appropriate Medi-Cal provider number. If the facility did not subpart and has one NPI for all locations, then each Medi-Cal provider number will need to be registered separately using the one NPI.

A: The NPIC tool registration began September 1, 2006 and continues to be available.

A: The NPIC tool is available through the Register, Update or Inquire About NPIs page. Providers will need to enter their current Medi-Cal provider number and one of the following for authentication:

• PIN (Provider Identification Number)
• Last four digits of SSN (Social Security Number)
• Last four digits of TIN (Taxpayer Identification Number)

A: No. In addition to registering an NPI with Medi-Cal using the online registration tool, the following methods may also be used:

• Hard copy registration using the National Provider Identifier Registration Form began December 1, 2006. This option is intended for use by providers who do not have Internet connection. Forms can also be obtained by calling the TSC at 1-800-541-5555 and selecting option 16, followed by option 18.
• The NPI Bulk Registration Tool is available for registering a large number of NPIs at the same time (mass registration). Providers should review the BRT instructions for details and technical requirements on file submission using the mass registration tool.

A: Yes. A provider needs to be active in the Medi-Cal program in order to register.

A: Yes. The purpose of BRT is to register a large number of NPIs at the same time.

A: Yes. If a provider applied for an individual NPI from NPPES, the provider’s individual NPI may be included in a bulk registration where a large number of NPIs are registered at the same time.

A: The BRT is a solution for Medi-Cal and Child Health and Disability Program (CHDP) providers that need to register a large number of NPIs at the same time. The BRT is designed to accept an electronic file containing an NPI as well as unique identifying information such as existing Medi-Cal provider numbers, PINs, TINs or SSNs. Please refer to the BRT instructions for more information.

A: No. The BRT does not send a confirmation to every provider registered, but it does provide a File Control Number (FCN) to the provider who submitted the file. The FCN may be used to inquire on a submitted file.

A: The BRT will accept any number of NPIs as long as the file does not exceed the 2 MB (megabyte) file size limitation.

A: Yes. A provider can make an “inquiry” to view an already submitted registration. Choose the “Inquiry/Update NPI” option on the NPIC main menu to view a registration. The deadline for making updates to your registration using the online NPIC tool was December 14, 2007. For providers who are not a facility licensed by the California State Department of Public Health (CDPH), NPI registration updates must now be submitted using the Medi-Cal Supplemental Changes (DHCS 6209) form with a detailed cover letter 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.

A: After an NMP has obtained their NPI, a supervising physician registers their NPI by including it in the Additional NMP NPI Information box along with the required license number using the NPIC tool or on the National Provider Identifier Registration Form.

A: The Provider Master File or PMF is being updated daily for all NPI registrations.

A: EDS has a contractual obligation to process the form in 5 business days from the date of receipt.

A: The PIN or last 4-digits of the TIN or SSN is used for authenticating the Medi-Cal provider during the registration process.

A: Yes. Effective May 23, 2007, applicants and providers will be required to submit their NPI with each Medi-Cal provider application package. For more information, please refer to the Revised Application Form Requirements, Procedures Due to NPI Implementation article.

A: The provider will need to inquire with their organization to determine if the NPI has been registered. If the provider has the PIN or TIN used by the organization, they may inquire using the NPIC tool by choosing the “Inquiry/Update NPI” option on the NPIC main menu.

A: Yes, Providers will need to contact the other carriers or insurances companies to find out how they are collecting provider NPIs.

A: Effective May 23, 2007, applicants and providers are required to submit their NPI with each Medi-Cal provider application package. For more information, please refer to the Revised Application Form Requirements, Procedures Due to NPI Implementation article.

A: The NPI must be registered with Medi-Cal if the doctor is a Medi-Cal provider. If a provider does not have a Medi-Cal provider number, they may not bill the Medi-Cal program directly so they do not have to register an NPI at this time. However, if the individual provider is a covered entity, as defined by the NPI Rule, the provider must apply for an NPI and their NPI must be included on all claims the primary provider submits to Medi-Cal for reimbursement.

A: Ensure that the PIN, SSN or TIN is correctly entered. A provider may verify their information by calling the Telephone Service Center (TSC) at 1-800-541-5555. Select option 16 from the main menu and then select option 18 from the sub menu.

A: No. Only active Medi-Cal or CHDP providers can register their NPI with Medi-Cal. However, if the contractor is a covered entity, as defined by the NPI Rule, they must apply for an NPI and their NPI must be included on all claims the direct provider submits to Medi-Cal for reimbursement.

A: No. An individual provider has the same PIN. However, if multiple provider numbers were replaced by a single NPI, the PIN from the first provider number entered during the registration process will be transferred to that NPI and the same PIN can be used to access the POS system.

A: For a Medi-Cal and CHDP provider, the NPI will automatically be updated for both programs when a provider registers their NPI with Medi-Cal.

A: The NPI registration tool allows Medi-Cal or CHDP providers to register one NPI for each active Medi-Cal or CHDP provider number currently enrolled. Providers possessing more than one active Medi-Cal or CHDP number will need to login separately for each existing number, and may enter the same NPI, or subpart NPI to replace their multiple Medi-Cal or CHDP numbers. The NPIC tool does not allow registration of more NPI numbers than existing Medi-Cal or CHDP provider numbers. 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.

A: Registering NPIs used to bill Medicare will allow Medi-Cal to process your Medi-Cal crossover claims. If you obtain and bill Medicare with NPIs not “known” to Medi-Cal, your crossover claims will not be processed correctly. If a provider is not a facility licensed by the California Department of Public Health (CDPH), they must submit the Medi-Cal Supplemental Changes (DHCS 6209) form to enroll NPIs used to bill Medicare. For providers licensed by the CDPH, subpart NPIs may be registered in accordance with the instruction provided in the NPI Registration for Facilities article.

A: No. When a provider obtains new NPIs for each of the Medi-Cal legacy numbers, a new record with a new PIN will be created for each of the NPIs. Providers will receive a letter notifying them of the PINs associated with the new NPIs . Providers must use the new PINs, not the PINs associated with the legacy numbers.

A: Medicare claims that crossover without an NPI registered with Medi-Cal will not be processed. The NPI used for billing Medicare must be the same NPI registered with 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 that enumerated at a payer, program or location level and use different NPIs to bill for the same types of services may want to reconsider that practice. The next Transaction and Code Set standards (version 5010) scheduled to become a regulation requires that providers use one NPI for the same types of services billed to all payers instead if being optional for the 4010A1 transaction. This means providers that elected to enumerate differently from payer to payer will be required to make changes when Medi-Cal implements version 5010. Therefore, it may be in the provider’s best interest to evaluate their enumeration practices before the version 5010 regulation becomes effective.

Currently, this practice affects providers billing for “Medi/Medi” or “dual-eligible” beneficiaries. If the NPI used to bill Medicare is not identical to the one used for Medi-Cal, the claims cannot crossover electronically from the Coordination of Benefits Contractor (COBC) successfully. As a result, providers will then have to submit paper claims for reimbursement.

A: No. Providers do not need to obtain a separate NPI for each program. One NPI can be registered with each of the programs you are enrolled in. Providers must register the one NPI for each Medi-Cal provider number separately using the NPIC online tool or a hard copy registration form. 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.