Complete Implementation of NPIs

Updated September 3, 2008

Medi-Cal and the Child Health and Disability Prevention (CHDP) program currently accept the National Provider Identifier (NPI) on all paper and electronic claims and transactions. To comply with the federally mandated NPI utilization date of May 23, 2008, providers should use their NPI instead of the legacy provider number. Providers that do not use an NPI on Medi-Cal and CHDP claims are out of compliance.

Medi-Cal and CHDP will continue to accept legacy provider numbers through September 30, 2008 only. Providers that have registered their NPI but have not submitted claims using their NPI will not experience interruption in payments for claims submitted with a legacy provider number. However, effective October 1, 2008, claims submitted with a legacy provider number will be denied.

The exceptions to this requirement for Medi-Cal claims are blood banks, Christian Science Practitioners and Multipurpose Senior Services Program providers. These providers may continue to submit Medi-Cal claims with a legacy provider number. The exception is also applicable to Medi-Cal Managed Care plans when reporting CHDP health assessment information on the CHDP Assessment Confidential Screening/Billing Report (PM 160INF) form.

The Department of Health Care Services (DHCS) will continue to end-date all Medi-Cal and CHDP legacy provider numbers for those providers who successfully submit a claim using an NPI.

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

• For the rendering provider fields, the legacy number may be used and the group’s NPI must be entered in the billing provider field.
• For attending, admitting, operating, referring or prescribing provider fields, the legacy number or license number may be used.

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. To comply with the NPI final rule, Medi-Cal plans to accept only the NPI in secondary provider fields. The implementation of NPI utilization for secondary providers will be published in a future Medi-Cal Update.

Resources will continue to be available to assist in the registration of the NPI through Medi-Cal’s Telephone Service Center (TSC) at 1-800-541-5555. Select language reference (option 11 for English; option 12 for Spanish), select option 16 from the main menu, then option 18 for the NPI helpdesk.