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.
Got Questions? Need More Information?
Still not sure what an NPI is and how you can get it, share it? Click to view the Frequently Asked questions regarding NPI registration. Providers may also contact First Health at (800) 639-5195.
Still not sure how to submit claims with your NPI? Providers may also refer to the Provider Billing Instructions or contact Provider Relations at (800) 807-1232 or the EDI helpdesk at (800) 205-4696
Attention Providers: May 23 is only 4 weeks away. Are you prepared?
Monday April 28;
The Department for Medicaid Services reminds 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, May 22, 2008. Since NPI is a Centers for Medicare and Medicaid Services 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.
Note: The NPI is the only value acceptable in any provider ID field on a claim, effective May 23, 2008. A taxonomy should also be submitted along with the NPI on the claim, in the case where a provider has registered one NPI with DMS but has enrolled and is billing claims for multiple provider types.
Providers enrolled as Hands, Commission for Handicapped Children, Title V, First Steps, Impact Plus and Non-emergency Transportation are considered Atypical Providers and are not required to submit an NPI and taxonomy on the claim. Atypical providers will continue to submit the legacy provider number.
To verify whether you or your billing vendor needs or is using an NPI, or would like to learn how you or your billing vendor can obtain, file and use an NPI, refer to the following Web sites for more information
Announcement - Policy Clarification for Tamper Resistant Prescription Pads (TRPP)
Tuesday April 8;
The April 1, 2008 implementation of the tamper-resistant prescription pad requirements for written prescriptions billed to Medicaid has been successful thus far. However, there are policy clarifications that seem appropriate based on the questions received. To view the clarifications, click the Policy Clarification for Tamper Resistant Prescription Pads.
Announcement - Tamper-resistant Prescription Pads Requirements effective April 1
Friday, March 21;
Effective April 1, Medicaid will require all written prescriptions for outpatient drugs, including over-the-counter drugs, to be on tamper-resistant prescription pads. As you may recall, Congress mandated the new requirement last year, but temporarily postponed implementation until April 1 to allow more time for states to respond.
For more information about the tamper-resistant pads, click on the General Provider Letter #A-80 - Tamper-resistant Prescription Pads Requirements Effective April 01, 2008.