June 3, 2008

In accordance with the National Provider Identifier (NPI) final rule, when a provider identifier is submitted on a paper or electronic claim by an ordering, referring, attending, operating, supervising, purchased service, other, service facility provider or by a prescriber submitting in the 837 institutional or professional format or performing a National Council for Prescription Drug Programs (NCPDP 5.1) transaction, that provider identifier must be an NPI.

If the entity identified as the ordering, referring, attending, operating, supervising, purchased service, other, service facility provider or prescriber does not furnish an NPI at the time of the order, referral, purchase or time of service, the billing provider should attempt to obtain that NPI to use it on the claim by either contacting the provider or obtaining the NPI information through the NPI Registry.

For Medi-Cal claims, below are the instructions for secondary provider identifier use if all attempts to acquire the NPI are unsuccessful:

• A valid NPI should be entered in the attending, admitting, or operating provider ID field. If the NPI is not available, providers may enter the nine-digit Medi-Cal provider number, or a license number.
• A valid NPI should be entered in the referring (prescribing) provider field. If an NPI for the referring provider is not available, providers may enter the nine-digit Medi-Cal provider number, or a license number.
• A valid NPI should be entered in the rendering provider field. If an NPI for the rendering provider is not available, providers may enter the existing nine-digit Medi-Cal provider number. The group’s NPI must be entered in the billing provider field.

Medi-Cal will allow the use of the Medi-Cal provider number or license number in the fields identified above while providers transition to sole use of the NPI. Billing providers are strongly encouraged to transition to exclusive NPI use as soon as possible. To comply with the NPI final rule, Medi-Cal plans to accept only the NPI in secondary identifier fields.

NPI Registry
The NPI Registry enables providers to search for an organization’s or individual provider's National Plan and Provider Enumeration System (NPPES) information. The registry describes the kinds of information available for providers, as well as instructions about how to obtain it.