The Department of Health Care Services (DHCS) conducts periodic deactivations of providers that have not billed Medi-Cal for 12 consecutive months and is not required to provide notice to the affected providers. On September 21, 2007, a mass deactivation of providers that had not submitted a claim or received reimbursement within a 12-month period took place.

Exceptions: Providers located in counties where Medi-Cal is administered by a county pre-paid health program are exempt from periodic inactivation.

Physicians who render Medi-Cal services but have their billing done by a medical group under a group number will remain in “rendering provider” status and are not subject to periodic inactivation.

For more information about this policy, see the Provider Guidelines section in the Part 1 manual.

NPI Registration Not Valid for Deactivated Providers
Providers that have already registered their National Provider Identifier (NPI) and are deactivated prior to or at the time of Medi-Cal’s conversion of the legacy provider number to the NPI will not have an NPI record on file. The NPI registration becomes invalid for providers deactivated before the conversion process in November 2007.

As such, providers will not be able to use the NPI in billing, communication and/or any transactions with Medi-Cal regardless of any NPI registrations made prior to the deactivation. However, providers submitting claims for dates of service prior to their deactivation may use their old legacy provider number.

Providers wishing to be reactivated must complete a provider-specific Medi-Cal enrollment application and submit it to the Provider Enrollment Division. Providers may also call the Telephone Service Center (TSC) at 1-800-541-5555 to obtain an application.