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Register NPI Used in Medicare Crossover Claims

 

 

 

What's New

May 5, 2008

Providers are strongly urged to register with Medi-Cal any National Provider Identifiers (NPIs) used on Medicare claims. Claims that electronically cross over to Medi-Cal with an NPI not registered with Medi-Cal will not be processed. The Department of Health Care Services (DHCS) has concerns about the validity of data entered in the "Additional NPI/Medicare NPI Information" field previously available on the National Provider Identifier Collection (NPIC) tool on the Medi-Cal Web site, Bulk Registration Tool (BRT) file submissions and on the paper registration forms. Therefore, these additional NPIs were not registered. Below are details about how to register your Medi-Cal NPI and information to consider if you obtained a separate NPI for Medicare claims.

It is imperative to register your NPI(s) with Medi-Cal as soon as possible to avoid interruption in crossover claim payments.

If providers are using NPI(s) consistently for all payers, including both Medi-Cal and Medicare claims, but have not registered their NPI(s) with Medi-Cal, they can do so using any of the three methods listed below.

 

If providers have already registered an NPI with Medi-Cal, and have received a separate NPI for Medicare claims, Medi-Cal recommends they reconsider their plans for not using NPI(s) consistently for all payers. If they still desire to use payer-specific NPI(s), they must report registration changes as noted in this article. There are two registration changes described in this article: one for licensed facilities and one for all other providers. Providers should choose the method that fits their business needs.

 

·           Providers should also remember that receiving an NPI from the National Plan and Provider Enumeration System (NPPES) is only the first step. The final step is sharing their NPI with payers and other business partners with whom they do business.

Providers must register their NPI with Medi-Cal using one of the following three methods:

 

• National Provider Identifier Collection (NPIC) tool – This tool allows NPIs to be registered one at a time, quickly and for free. Providers may access the NPIC through the Register/Update/Inquire NPIs page.

• NPI Bulk Registration Tool (BRT) – The BRT is available to providers who would prefer to register multiple NPIs at the same time using the NPIC online system. Providers should review the BRT instructions to access specific information about the NPI BRT and technical requirements for file submission.

• NPI Paper Registration – The paper registration process is intended for providers who do not have Internet access. They may call the Telephone Service Center (TSC) at 1-800-541-5555 to request the NPI Registration Form. After completing the required information, they should return the form with their National Plan and NPPES verification document to the address identified at the bottom of the form.

NPI Registration for Facilities
Facilities that are licensed and/or certified by the California Department of Public Health (CDPH) and find that NPIC does not allow them to accurately register their NPIs may do so by submitting a letter to the DHCS Provider Enrollment Division (PED). The requirements for this letter are as follows:

 

• Must be on the provider’s letterhead and signed by an individual authorized to act on behalf of the provider

• Must state the authorized individual’s contact information and role with the organization

• Must include a summary of the requested action, and clearly detail what services will be billed or performed under each NPI, and an effective date for use of the additional NPI(s)

• Must include the facility service address for NPI(s) being submitted

One of the following types of NPI verification must be included with the letter:

 

• NPI notification letter from the NPPES

• ·NPI notification e-mail from NPPES

• ·NPI notification from the Electronic File Interchange Organization via letter or e-mail

•  Screen print from the NPI Registry

 

The letter, including applicable NPI verification, should be mailed to:

 

ATTN:  Facilities and Programs Unit
Department of Health Care Services
Provider Enrollment Division
MS 4704
P.O. Box 997413
Sacramento, CA  95899-7413

 

The registration alternative described above is for use by licensed facilities only. Furthermore, PED will not add business (service) locations, categories of services, etc., beyond what has been previously approved by CDPH. Any provider wishing to request such a change should contact CDPH’s Licensing and Certification Division.

 

Providers who are not licensed facilities should continue to report changes to their NPI registration by submitting a Medi-Cal Supplemental Changes form (DHCS 6209), revised 2/08 or later, with a cover letter detailing the NPI changes. Form DHCS 6209 includes a page to assist in NPI sub-parting. Providers may obtain this form by calling the Telephone Service Center (TSC) at 1-800-541-5555 and choosing option 16, followed by option 18.