NPI UPDATE–Know Your NPI Requirements
November 12th, 2007
MEDICARE: Submission of an NPI for an ordering/referring provider will be mandatory as of May 23, 2008 for all Medicare claims. When an identifier is reported on a claim for ordering/referring/attending provider, operating/other/service facility provider, or for any provider that is not a billing, pay-to or rendering provider, that identifier must be an NPI. Legacy numbers cannot be reported on any claims sent to Medicare on or after May 23, 2008.MEDICAID: Submit both NPI and Medicaid Provider Number on Claims. Beginning January 1, 2008, NC Medicaid physician providers must begin submitting both the NPI and the Medicaid Provider Number on all claims. While claims will not be denied at this time if this information is not submitted, not providing this information now may cause your claims to be denied once NPI is fully implemented on May 23, 2008. Both numbers are currently needed to ensure that a provider’s NPI and Medicaid Provider Number are mapping correctly. NCECS web is being modified to allow the submission of both the NPI and the Medicaid Provider Number. If your software is not updated to submit the NPI number, please contact your clearinghouse or software vendor as soon as possible to obtain the appropriate updates. Please ensure that you keep the capability to submit the Medicaid Provider Number along with the NPI.
Medicaid Pharmacy Claims Will Require NPI: Currently, the prescriber’s Drug Enforcement Administration (DEA) number is used as an identifier on Medicaid pharmacy claims. Upon NPI implementation on May 23, 2008, the NPI will replace the DEA number. Pharmacists are being encouraged to begin requesting the NPIs of prescribers. Some prescribers have elected to add their NPIs to their prescription pads.
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