National Provider Identifier (NPI)

DNNDMZQualSU posted on March 02, 2009 11:18

Alert! Alert! Alert!

Idaho Medicaid NPI implementation delayed until 5-29-2007!

The NPI implementation date for Idaho Medicaid is delayed until May 29, 2007. Please continue to submit electronic 837 claim transactions with:

Both the NPI and Idaho Medicaid provider number, or

Only the Idaho Medicaid provider number until May 29, 2007

Please submit NCPDP pharmacy transactions using the Idaho Medicaid provider number for the service (billing) provider. Use the state license number for the Prescriber ID.

Using Your NPI on Electronic Claims

Effective May 29, 2007, Idaho Medicaid will begin processing electronic claims using the NPI. Idaho Medicaid providers have three options for identifying themselves on electronic claims:

With your Idaho Medicaid Provider Number AND your NPI (recommended)
With your Idaho Medicaid Provider Number only
With your NPI only

1. Claims with your Idaho Medicaid Provider Number AND your NPI (This option does not apply to drug claims.)

It is a good idea to submit electronic claims with both your Idaho Medicaid Provider Number and your NPI so we can test your NPI before you rely on it for claims processing. Your Idaho Medicaid Provider Number will continue to be used to process and pay the claim.

We will compare the NPI you submit on the claim to information you provided when you registered the NPI. Although your NPI will not be used to process and pay the claim, having both your NPI and Idaho Medicaid Provider Number allows us to test how we would have paid the claim had we used the NPI. This will help us identify providers who need additional assistance before submitting claims with the NPI only.

2. Claims with your Idaho Medicaid Provider Number only

Idaho Medicaid will continue to process and pay claims using the Idaho Medicaid provider number for providers who are not ready or who are not required to send an NPI.

CMS has granted a contingency period until May 2008, for providers who are making a good faith effort to comply with NPI regulations. One way to show a good faith effort is to get and register an NPI with Idaho Medicaid.

3. Claims with your NPI only

We will process and pay the claim using your NPI. We recommend that you verify that your NPI is correctly linked to your Medicaid Povider number before you submit claims with only your NPI.

Idaho Medicaid will pay the claim based on the Idaho Medicaid provider number you linked this NPI to during the registration process. We will also use the zip code that you updated during the registration process to identify your service location.

If you are unsure about what information you provided during registration, you can review your NPI account information at the Idaho Medicaid NPI registration website at: https://npi.dhw.idaho.gov/idahoNpi/. If you can’t remember your user ID or password, contact the NPI Registration Help Desk at (866) 909-4148.

If you have one NPI linked to one Idaho Medicaid Provider Number

Use your NPI as your provider number.

If you have one NPI linked to more than one Idaho Medicaid provider number

You must submit a taxonomy code on your electronic claim. The taxonomy codes that Idaho Medicaid will accept for each provider specialty can be found by clicking the taxonomy code link to the right. This information has been added to the Provider Handbook as an appendix. The most recent Provider Handbook was included on the Provider Resources CD that is mailing to you in May 2007.
During the registration process, you updated the zip code for each of your service locations. You must include this Zip+4 (9-digit zip code) to designate the service location on your claim.

If you have any questions about using your NPI, please contact your local Provider Relations Consultant (PRC). Contact information for your PRC can be found in this newsletter.

NPI Claims Processing Information

NPI information for providers who submit 837 electronic claims

NPI information for pharmacies

Web Registration Instructions

NPI Registration Quick Tips

Tips for Linking Your NPI to a Medicaid Provider Number

Individual Registration instruction guide. Individual providers are a person or sole proprietorship.

Organization Registration instruction guide. Organization providers are hospitals, clinics, group practices, nursing homes, etc.

NPI Topics

NPI Frequently Asked Questions - Updated 9/12/07

Taxonomy Codes

Taxonomy Codes for Idaho Medicaid Providers