January 2, 2008

Effective February 15, 2008, in accordance with Centers for Medicare & Medicaid Services (CMS) requirements, the Department of Health Care Services (DHCS) is revising all provider enrollment application forms to accommodate the National Provider Identifier (NPI). The Medi-Cal program is discontinuing the practice of assigning a Medi-Cal provider number, also referred to as a legacy number. Implementation of the NPI, including the discontinuation of all legacy numbers, is a requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). However, the Denti-Cal program may continue to assign legacy numbers to providers to be used in coordination with the NPI beyond February 15, 2008.

Information in this provider bulletin is effective February 15, 2008, and published based on the authority granted by Welfare and Institutions Code (W&I Code), Section 14043.45(c) and supersedes the previous provider bulletin titled “Revised Application Form Requirements, and Procedures due to National Provider Identifier (NPI) Implementation,” that stated an effective date of May 23, 2007.

As part of this implementation, the NPI is being adopted as the provider number for Medi-Cal providers. Consequently, as of February 15, 2008, any reference in California Code of Regulations (CCR), Title 22, referring to Medi-Cal provider numbers shall be considered to refer to the NPI.

Enrollment Procedures and Requirements
When requesting enrollment, applicants must submit any NPIs used at the business location with the appropriate revised application forms listed below to enroll as a Medi-Cal provider.

DHCS will not process any application package or form without valid NPI verification. Applicants must submit verification of each NPI submitted to DHCS with any application package. When submitting a Medi-Cal Supplemental Changes form (DHCS 6209), the applicant must include verification for any new NPIs submitted to DHCS. If the applicant or provider is directly billing for services (for example, not only rendering services as a member of a provider group), the business address on the NPI verification must match the business address identified on the application package.

Acceptable verification includes:

• An NPI notification letter from the National Plan and Provider Enumeration System (NPPES).
• An NPI notification e-mail from NPPES.
• An NPI notification from the Electronic File Interchange Organization (EFIOs) via letter or e-mail; or
• A screen print from the NPI Registry.

By submitting one or more NPIs to DHCS, applicants and providers are attesting that they will comply with the NPI requirements established by the NPI Final Rule and as CMS has specified since and may specify in the future. Failure to register NPI(s) in accordance with CMS requirements may result in delayed payment of claims submitted to Medi-Cal.

The revised forms listed below are required for all application and disclosure packages received by DHCS on or after February 15, 2008. All references to the forms below in CCR, Title 22, Division 3, are amended to reflect the February 2008 version:

• Medi-Cal Durable Medical Equipment Provider Application (DHCS 6201)
• Medi-Cal Orthotics and Prosthetics Provider Application (DHCS 6202)
• Medi-Cal Provider Group Application (DHCS 6203)
• Medi-Cal Provider Application (DHCS 6204)
• Medi-Cal Pharmacy Provider Application (DHCS 6205)
• Medi-Cal Medical Transportation Provider Application (DHCS 6206)
• Medi-Cal Disclosure Statement (DHCS 6207)
• Medi-Cal Provider Agreement (DHCS 6208)
• Medi-Cal Supplemental Changes (DHCS 6209)
• Medi-Cal Physician Application/Agreement (DHCS 6210)
• Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers (DHCS 6216)
• Successor Liability with Joint and Several Liability Agreement (DHCS 6217)
• Medi-Cal Nonphysician Medical Practitioner and Licensed Midwife Application (DHCS 6248)

Atypical Providers
Providers who are not eligible to receive an NPI (“atypical providers”) are not required to submit an NPI and should instead enter the word “atypical” in the NPI field. These atypical providers receive a unique Medi-Cal provider number once the application is approved.

Taxonomy Codes
Each applicant must submit all taxonomy codes provided in their original application to CMS/NPPES.