Attention: Orthotic and Prosthetic Providers

Billing (Supplier) and Attending (Fitting) (NPI) National Provider Identification Information

When applying for a National Provider Identification (NPI) number, orthotic and prosthetic providers should note that the Centers for Medicare and Medicaid Services (CMS) requests different information from individual providers and organizations. Providers should go to the CMS Web site at https://nppes.cms.hhs.gov for clarification of the rules regarding their NPIs.

The N.C. Medicaid Web site contains links to important information regarding NPI at http://www.ncdhhs.gov/dma/NPI.htm. Included in these references is how individuals’ and organizations’ NPIs will be collected by N.C. Medicaid.

The CMS NPI fact sheet gives further clarification of who should apply for an NPI and other important information.

NPI – Get it! Share It! Use It! Getting one is free – Not having one can be costly!

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

National Provider Identifier (NPI) Seminar

National Provider Identifier (NPI) seminars are being held during the month of January 2007. Seminars are intended for providers that would like more detailed information on how N.C. Medicaid will be implementing NPI. Please go to http://www.dhhs.state.nc.us/dma/NPI/NPI%20Agenda.pdf to access the agenda to see specific topics that will be discussed.

The seminars are scheduled at the locations listed below. Pre-registration is required. Due to limited seating, registration is limited to two staff members per office. Unregistered providers are welcome to attend if space is available.

Providers may register for the NPI seminars by completing and submitting the registration form online at http://www.dhhs.state.nc.us/dma/semreg/seminar_npi.aspx. If you are planning on attending the Raleigh location that has two sessions, please indicate the session you plan to attend on the registration form.

Morning sessions of the seminars will begin at 9:30 a.m. and end at 11:30 a.m. Providers are encouraged to arrive by 9:15 a.m. to complete registration. Afternoon sessions will begin at 1:30 p.m. and end at 3:30 p.m. Providers are encouraged to arrive by 1:15 to complete registration.

Providers may access the Special December 2006 Bulletin, New Claim Form Instructions using the following link: http://www.dhhs.state.nc.us/dma/bulletin/NewClaimFormInstructions.pdf. Providers should contact EDS with any billing questions.

Providers must print the PDF version of the Special December 2006 Bulletin, New Claim Form Instructions and bring it to the seminar.

Please use the registration form to register for the following seminars.

Directions to the seminars.

Monday, Jan. 8, 2007

Jane S. McKimmon Center

1101 Gorman St.

Raleigh, NC 27606

Tuesday, Jan. 9, 2007

Coastline Convention Center

501 Nutt St.

Wilmington, NC 28401

Tuesday, Jan. 16, 2007

Matthews Community Center

100 McDowell St. E.

Matthews, NC 28105

Wednesday, Jan. 24, 2007

Crown Plaza Hotel and Resort

One Holiday Inn Drive

Asheville, NC 28806

NPI – Get it! Share It! Use It! Getting one is free – Not having one can be costly!

Attention: All Providers

National Provider Identifier (NPI) Collection Form Now Available in Spreadsheet Format

N.C. Medicaid is actively collecting NPI numbers from providers. Providers are required to report NPI numbers to Medicaid no later than March 31, 2007. To accommodate organizations with large numbers of providers, an NPI spreadsheet is now available on the DMA Web site. The spreadsheet and its instructions can be found here: http://www.dhhs.state.nc.us/dma/NPI.htm. The spreadsheet can be completed for both group and individual provider numbers. Required fields for the spreadsheet are similar to the NPI Collection Form. Blocks A through L on the spreadsheet must be completed.

Printed Name/Title/Date, Phone Number, Fax Number and Email Address — List the person completing this information and the contact information for questions.

• A. Group (G)/Individual (I) — You may submit both group and individual information on the same spreadsheet. Enter the group information first by putting a “G” in column A. The indicator G is for the Group NPI. Next, enter an “I” for each individual in the group. Please complete a separate line to report the NPI for each Medicaid Provider Number.

• B. Carolina ACCESS Provider — Place a “Y” or “N” in column B for each Medicaid Provider Number to indicate whether the group or the individual is a Carolina ACCESS provider.

• C. Medicaid Provider Number — Enter the seven- or eight-digit numeric or alphanumeric Medicaid Provider Number. Please check the most recent remittance advice (RA) to make sure the provider number is accurately recorded. Complete a separate line to report the NPI for each Medicaid Provider Number.

• D. National Provider Number (NPI) — Enter the 10-digit number assigned by NPPES for each Medicaid Provider Number. In addition to submitting the spreadsheet, providers must submit a copy of their NPPES certification letter for each NPI reported. If you do not submit this letter, your NPI will not be accepted. If you need to apply for an NPI, go to https://nppes.cms.hhs.gov/NPPES/Welcome.do and click on the link to National Provider Identifier. Follow the instructions for applying.

If you need a copy of your NPPES Certification letter, contact the NPI Enumerator at 1-800-465-3203, or go to http://questions.cms.hhs.gov/copy of your NPPES letter to have another NPI notification generated. If the provider was enumerated via EFI, the health care provider must contact the EFI organization (EFIO) for a copy of the EFIO’s notification. Notifications generated by the NPPES are created in the same manner in which they were originally issued (i.e., NPI notification letter for paper applicants or an e-mail notification for Web-based applicants).

E. Taxonomy — Enter the 10 digit code ending in X. You may submit up to 15 taxonomies. If you need to report additional taxonomy codes, please complete the “Additional Taxonomy Form” located at http://www.ncdhhs.gov/dma/npi/taxonomy.htm. For a listing of taxonomy codes, go to http://www.wpc-edi.com/taxonomy. You will need this taxonomy information when applying for an NPI.

• F. Organization/Individual Name

o Organization Name — The name of the group or business. Please check the most recent RA to verify how your organization is listed in our provider system. If the name on the spreadsheet does not match the name listed in the provider system, the updates will not be made.

o Individual Name — The name of the provider as listed in our system or on the NPPES certification. If the name on the spreadsheet does not match the name listed in the provider system the updates will not be made.

• G-L. Physical/Accounting Address — Must be completed even if the addresses are the same.

o Physical Address — The location where services are performed or care is coordinated. Please be sure to include the ZIP Code+4 number.

o Accounting Address — The address where payments, remittance advices and correspondence are sent. Please be sure to include the ZIP Code+4 number. Please check the most recent RA to determine the accounting address listed in our provider system. If the accounting address is the same as the physical address, please indicate “SAME” in this block.

NOTE: If the address on this spreadsheet does not match what is currently in our provider system, we will automatically update our records with the address provided on the NPI spreadsheet. For reporting changes other than address, complete the Provider Change Form which is located here: www.ncdhhs.gov/dma/forms.html.

Upon completion, choose one of the options below to send the spreadsheet to DMA:

Please Mail to:

DMA Provider Services

Attention: NPI Form

2501 Mail Service Center

Raleigh, NC 27699-2501

Please Fax to:

(919) 715-7140

Please E-mail to:

npi.dma@ncmail.net

NPI – Get it! Share It! Use It! Getting one is free – Not having one can be costly!

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

March 2007 National Provider Identifier (NPI) Seminars

Informational seminars regarding National Provider Identifier (NPI) are scheduled for March 2007. Registration information and a complete list of dates and site locations for the seminars will be published in the February 2007 general Medicaid bulletin and published on DMA’s Web site at http://www.ncdhhs.gov/dma/NPI.htm.

NPI – Get it! Share It! Use It! Getting one is free – Not having one can be costly!

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Required Fields on New Provider Enrollment Applications and Provider Change Form

Effective Jan. 1, 2007, to facilitate National Provider Identifier (NPI) implementation, the Division of Medical Assistance (DMA) will no longer accept enrollment applications or change forms without the following information:

National Provider Identifier (NPI)
Zip Code plus Four
Taxonomies

Federally mandated requirements for NPI implementation is May 23, 2007. This information is required. If this information is not provided, your new application or change forms will be returned.

If you have not enumerated, please check our Web site at http://www.dhhs.state.nc.us/dma/NPI.htm for information or enumerate at NPI at https://nppes.cms.hhs.gov/NPPES/Welcome.do.

NPI – Get it! Share It! Use It! Getting one is free – Not having one can be costly!

Providers Services

DMA, 919-855-4050

Attention: All Providers

Submitting Both National Provider Identifier (NPI) and Provider Number on Claims

N.C. Medicaid would like to encourage providers to begin submitting both the National Provider Identifier (NPI) and the Medicaid provider number on electronic claims no later than Jan. 1, 2007. 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. N.C. Medicaid will continue to process claims using the Medicaid provider number until NPI is implemented in May 2007.

The NCECS Webtool already contains a field for submitting the NPI, so providers can begin to populate that field. For providers who bill on paper, the new paper claim forms will be available in 2007. We plan to begin testing changes to the MMIS in January 2007, and at that time we will need both the NPI and Medicaid provider numbers.

NPI – Get it! Share It! Use It! Getting one is free – Not having one can be costly!

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Updated National Provider Identifier (NPI) Collection Forms

The Division of Medical Assistance (DMA) is currently collecting National Provider Identifier (NPI) numbers from Medicaid providers. Health care providers are required to complete one NPI collection form for each Medicaid provider number to ensure that North Carolina Medicaid captures the NPIs, which will be used for claims processing. There are now two different collection forms on the DMA Web site: one for individual provider numbers and one for group provider numbers. Providers who have obtained an organizational or group NPI must complete an NPI collection form for the group provider number. In addition, an individual NPI collection form must be completed for each individual provider number within the group.

The required fields for completing the NPI collection form are: Medicaid Provider Number, NPI, Physical and Billing address including Zip+4 and taxonomy code(s). If more than three taxonomy codes need to be linked to one NPI number, an additional taxonomy page has been provided on the Web site. Providers can link up to 15 taxonomies to one NPI. Also, providers need to include a copy of the notification letter from the National Plan and Provider Enumeration System (NPPES). The address information provided will overlay the information currently in the system. Any other change request will require a separate change request form

The collection forms and instructions are located on the following Web site: http://www.dhhs.state.nc.us/dma/NPI.htm. Forms must be typed and returned no later than March 15, 2007. The form can be returned by the mail, fax or e-mail addresses listed on the form. Providers will receive a confirmation notice once the NPIs have been added.

NPI - GET IT, SHARE IT, USE IT! GETTING ONE IS FREE; NOT HAVING ONE CAN BE COSTLY!

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Corrected 2007 Checkwrite Schedule

This article from the December General Medicaid bulletin is being re-run with corrections. Corrections have also been made to the Checkwrite schedule on DMA’s Web site.

Beginning February 2007, the cutoff day for electronic claims submission will change from Friday to Thursday due to anticipated increased processing time for the National Provider Identifier (NPI) implementation. It is important that you make any required system changes to accommodate this cutoff day. The following is the 2007 checkwrite schedule:

Month	Electronic Cut-Off	Checkwrite Date
July	06/28/07	07/03/07
	07/05/07	07/10/07
	07/12/07	07/17/07
	07/19/07	07/26/07

August	08/02/07	08/07/07
	08/09/07	08/14/07
	08/16/07	08/23/07

September	08/30/07	09/05/07
	09/06/07	09/11/07
	09/13/07	09/18/07
	09/20/07	09/27/07

October	10/04/07	10/09/07
	10/11/07	10/16/07
	10/18/07	10/23/07
	10/25/07	10/31/07

November	11/01/07	11/06/07
	11/08/07	11/14/07
	11/15/07	11/21/07

December	11/29/07	12/04/07
	12/06/07	12/11/07
	12/13/06	12/20/07

Month	Electronic Cut-Off	Checkwrite Date
January	01/05/07	01/09/07
	01/12/07	01/17/07
	01/19/07	01/25/07

February	02/02/07	02/06/07
	02/08/07	02/13/07
	02/15/07	02/20/07
	02/22/07	02/28/07

March	03/01/07	03/06/07
	03/08/07	03/13/07
	03/15/07	03/20/07
	03/22/07	03/29/07

April	04/05/07	04/10/07
	04/12/07	04/17/07
	04/19/07	04/26/07

May	05/03/07	05/08/07
	05/10/07	05/15/07
	05/17/07	05/22/07
	05/24/07	05/31/07

June	05/31/07	06/05/07
	06/07/07	06/12/07
	06/14/07	06/21/07

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Clinical Coverage Policies

The following new or amended clinical coverage policies are now available on the Division of Medical Assistance’s Web site at http://www.ncdhhs.gov/dma/mp/mpindex.htm:

General Clinical Coverage Policy A3, Prior Authorization for Outpatient Pharmacy Point of Sale Medications

Clinical Coverage Policy 4A, Dental Services

Clinical Coverage Policy 5A, Durable Medical Equipment

Clinical Coverage Policy 5B, Orthotics and Prosthetics

Clinical Coverage Policy 10B, Independent Practitioners

These policies supersede previously published policies and procedures. Providers may contact EDS at 1-800-688-6696 or 919-851-8888 with billing questions.

Clinical Policy

DMA, 919-855-4260

Attention: All Providers

CPT Code Update 2007

Effective with date of service Jan. 1, 2007, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have added some new CPT codes, deleted others and changed the descriptions of some existing codes. (For complete information regarding all CPT codes and descriptions, refer to the 2007 edition of Current Procedural Terminology, published by the American Medical Association.) New CPT codes are covered by the N.C. Medicaid Program effective with date of service Jan. 1, 2007. Claims submitted with deleted codes will be denied for dates of service on or after Jan. 1, 2007. Previous policy restrictions continue in effect unless otherwise noted.

New Covered CPT Codes
00625	00626	15002	15003	15004	15005	15731	15830	15847	17311
17312	17313	17314	17315	19300	19301	19302	19303	19304	19305
19306	19307	22865	25109	25606	25607	25608	25609	27325	27326
28055	33202	33203	33254	33255	33256	33265