September 4, 2008

Effective October 1, 2008, the Department of Health Care Services (DHCS) will only accept the National Provider Identifier (NPI) on all Medi-Cal claims. As a result, DHCS also encourages providers to use only their NPI for Treatment Authorization Requests (TARs) in order to minimize denials or rejections of claims. The exceptions to this requirement for claims and TARs are “atypical” providers such as Blood Banks, Christian Science Practitioners and Multipurpose Senior Services Program providers that will continue to use Medi-Cal legacy provider numbers. 

DHCS encourages providers to use the NPI on TARs as well as claims to avoid claim problems. However, the Medi-Cal Field Offices and Pharmacy Sections will continue to accept and process TARs containing either a valid NPI or Medi-Cal legacy number.  

When a Medi-Cal legacy provider number has already been end-dated due to successful NPI claim submission or due to the end-of-transition deadline of October 1, 2008, claims for dates of service after either of those dates must be billed using the NPI. If a Medi-Cal legacy provider number is used the claim will be denied.  

Until October 1, 2008, the Medi-Cal Field Offices and Pharmacy Sections will continue to correct TARs authorized with a Medi-Cal legacy number when providers receive a claim denial due to a provider number mismatch. Providers should submit TARs using the NPI for dates of service rendered pre- and/or post-NPI implementation once cross-referencing of the NPI to their Medi-Cal legacy number is successful. 

As long as a Medi-Cal provider is submitting a TAR with a legacy number rather than an NPI, the provider must ensure that the registered NPI on the claim is cross-referenced to the Medi-Cal legacy number that was previously used for TAR submissions. The cross-referencing system allows the legacy number to be used for a TAR when a claim is submitted using an NPI.

Note:

Providers must have an NPI and a legacy provider number registered with Medi-Cal in order for the cross-reference system to work successfully. Provider NPI changes such as an address change, updates to NPI-related information or registering additional NPIs that are not on record with the DHCS Medi-Cal Provider Enrollment Division (PED) could prevent successful claims billing.

Providers can contact the Telephone Service Center (TSC) at 1-800-541-5555 to ensure their legacy numbers are properly cross-referenced to their NPI(s). After confirming whether or not cross-referencing of legacy identifiers to one (1) or many NPI numbers is accurate, providers may need to update their NPI registration. To do so, providers should submit a Medi-Cal Supplemental Changes (DHCS 6209) form to PED so the most current information will be on record. For example, if a provider registers a different NPI or adds another NPI, the cross-referencing system may not contain any of the prior legacy numbers required to link the claim to the TAR for accurate processing. Any NPI registration that is not current may result in claims being denied or rejected.