 |
|
|
 |
 |
|
|
|
Clinical Coverage Policies and Provider Manuals
Proposed Medicaid Clinical Coverage Policies
Reporting a Change in Provider Status
Get It! Share It! Use It!
Getting one is free -
Not having one can be costly!
Full implementation of NPIs will take place on May 1, 2009. Upon full implementation, the Medicaid Provider Number (MPN) will no longer be allowed on paper or electronic claims. Claims submitted with the MPN will be denied unless the provider is atypical.
Effective May 1, 2009 and after, claims submitted with the Medicaid Provider Number will be denied unless the provider is atypical.
For all claims (except pharmacy) that are submitted electronically, a taxonomy code must be included for the billing provider. However, if the procedure or service is billed with an attending provider number, only the taxonomy code for the attending provider is included on the electronic claim submission. For paper claims, a taxonomy code for the both the billing provider and, if applicable, the attending provider must be included on the claim.
Note: Pharmacy providers must submit claims with their NPI number and the prescriber’s NPI number or DEA number entered on the claim.
For placement of data on the 837 transaction, consult the X12 Implementation Guide. The NCECSWeb tool now contains fields to report this information. For CMS-1500, UB-04, and ADA claim forms, consult the June 2007 Special Bulletin, New Claim Form Instructions.
The NPI and Address Database lists the NPI and addresses of active NC Medicaid providers (or providers who have been end-dated within the past 12 months).
To check to see if DMA has your correct NPI and address on file, search the NPI and Address Database.
If you have still have not reported your NPI to DMA, search the NPI and Address Database for your provider number and follow the instructions on the results screen
