National Provider Identifier (NPI)
Attention Providers: Additional Guidance and Clarification for Identifying Secondary Providers in KY Medicaid Claims.
Wendsday May 14;
In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for participating providers. For Kentucky Medicaid purposes, this requirement is effective May 23, 2008. If the entity to be identified as the participating provider does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the participating provider in order to obtain the NPI. While the Implementation guides for the 837 claims transactions permit the reporting of the Social Security Number (SSN) for some secondary providers if there is no NPI, we do not believe the billing provider will be successful in the obtaining the SSN.
- If unable to obtain the NPI of the entity to be identified in the service facility location loop, no identifier should be reported in that loop.
- If unable to obtain the NPI of the participating provider, the billing provider shall use its own NPI to identify those secondary providers. Kentucky Medicaid will not pay these claims if these secondary providers are not identified by NPIs after May 23, 2008
Note: Kentucky Medicaid is NOT allowing pharmacy providers to use their own NPI in the prescriber field on the claim. Pharmacy providers are to bill the NPI of the prescriber, if they have it. If they do not have the prescriber's NPI, the pharmacy provider should submit the prescriber's license number for a period of time, Medicaid, effective May 23, 2008 and after.
Still have questions? Need more Information? If so, click the links below for more information on:
Attention Providers: May 23, is only about 2 weeks away? Are you ready?
The Department for Medicaid Services (DMS) would like to remind providers and their billing vendors that the National Provider Identifier (NPI) and the taxonomy must be obtained, on file and used in claims submission before the end of the contingency date of May 22, 2008. Since NPI is a Centers for Medicare and Medicaid Services (CMS) mandate that has been in effect since May 23, 2007, DMS chose to allow providers a contingency period.
Claims received by EDS for processing submitted with both the NPI and legacy provider number OR just a legacy provider number will deny effective May 23, 2008.
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NPI Information |
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The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. Return to top of page
Providers who have not yet applied to FOX Systems for their NPI should do so as soon as possible.
Note: Providers who do not already have a taxonomy, may refer to the Washington Publishing Company to choose a taxonomy(s).
Health care providers can apply for NPIs in one of three ways:
- For the most efficient application processing and the fastest receipt of NPIs, use the web-based application process. Simply log onto the National Plan and Provider Enumeration System (NPPES) and apply on line.
- Health care providers can agree to have an Electronic File Interchange (EFI) organization (EFIO) submit application data on their behalf (i.e., through a bulk enumeration process) if an EFIO requests their permission to do so.
- Health care providers may wish to download a copy of the paper NPI Application/Update Form (CMS-10114) and mail the completed, signed application to:
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059 Return to top of page
Once providers obtain their NPI and taxonomy code(s), FOX Systems will issue verification. To submit your NPI and taxonomy code(s) to KyHealth Choices, print and complete this form and include with your FOX Systems verification. Mail or fax these documents to:
First Health
NPI/Taxonomy
P.O. Box 2110
Frankfort, KY 40602
Fax: (502) 607-8401
Providers, if you have additional questions about filing and sharing your NPI with Kentucky Medicaid, please see the list of Frequently Asked Questions about registration. Return to top of page
Providers who have registered their NPI and taxonomy(s) with Kentucky Medicaid should start billing both the correct NPI and taxonomy, on the claim effective for any dates of service on or after the day they were notified by Kentucky Medicaid that their NPI and taxonomy(s) were registered.
In addition, providers who have one NPI and multiple provider ID's should note that Kentucky Medicaid "strongly encourages and suggests" in order to uniquely identify the provider when processing claims, that the provider bill the appropriate taxonomy with the NPI.
For more information on how to bill with an NPI, refer to the Provider Billing Instructions. In addition, providers can reference the KY Companion guides for the appropriate 837 transactions they are billing. Return to top of page
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