National Provider Identifier (NPI)

What is National Provider Identifier (NPI)? The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for health care providers, the National Provider Identifier (NPI). NPI is 10 digits in length and will replace health care provider identifiers in use today, including the nine-digit Medi-Cal and six-digit Denti-Cal provider numbers.

NPI’s Implementation Dates Implementation of NPI for Denti-Cal providers will take place on May 23, For Medi-Cal providers, the implementation of NPI will take place on October 22, A dual-use period for Medi-Cal providers will begin on May 23, 2007 and end on November 25, 2007.

NPI’s Implementation Dates During this dual-use period, the Medi-Cal provider number and the NPI number will be required for all billing, communication, and/or transactions with Medi-Cal. Beginning November 26, 2007, only the NPI will be required for all billing, communication and/or transactions with Medi-Cal.

How Will the Implementation of NPI Impact SARs? Effective May 23, 2007, CMS Branch will start receiving a Provider Master File from Delta Dental which will cross reference the Denti-Cal provider number to the NPI number. If a user enters a Denti-Cal provider number in the SAR system and the Denti-Cal provider number is cross referenced to a NPI, the SAR system will display the NPI number on the screen as well as on the SAR.

How Will the Implementation of NPI Impact SARs? If the provider does not have a NPI, the SAR will be issued to their Denti-Cal provider number. Effective October 22, 2007, CMS Branch will start receiving the entire Medi-Cal Provider Master File and a cross reference file which will cross reference the Medi-Cal Provider number to the NPI number.

How Will the Implementation of NPI Impact SARs? Effective October 22, 2007, the SAR system will no longer allow users to modify the end date on SARs issued to the provider’s nine-digit Medi-Cal provider number. Effective October 22, 2007, if a user enters a Medi-Cal provider number in the SAR system and the Medi-Cal provider number is cross reference to NPI, the SAR system will display the NPI number on the screen as well as on the SAR.

Effective October 22, 2007, the SAR system will no longer allow SAR’s to be issued to the provider’s nine-digit Medi-cal provider number. How Will the Implementation of NPI Impact SARs?

Universal Procedure Codes (UPN) for Medical Supplies The Health Insurance Portability and Accountability Act (HIPAA) mandates the use of Healthcare Common Procedural Coding System (HCPCS) Level II codes on electronic medical supply claims. As a result, the California Department of Health Services (CDHS) plans to discontinue all interim medical supply codes and convert to HCPCS Level II codes.

Universal Procedure Codes (UPN) for Medical Supplies Medi-Cal requires authorization for medical supplies and Durable Medical Equipment based on dollar amounts and quantity. Many items never require an authorization. Once an item exceeds the limit an authorization is required. Currently every medical supply or piece of equipment provided to a CCS client requires a code specific SAR.

Universal Procedure Codes (UPN) for Medical Supplies The CMS Branch has written a System Development Notice (SDN) to the California Department of Health Services (CDHS) requesting that CDHS instruct EDS to follow Medi-Cal’s medical supplies non-TAR policies when processing CCS medical supply claims authorized with a SAR. The SDN also instructs EDS to accept and process non- TAR required medical supply claims when billed with a SAR issued to the provider ordering the medical supplies or equipment.

Universal Procedure Codes (UPN) for Medical Supplies Medical supply claims that exceed the non-TAR limit cannot be billed under the physician’s SAR and requires a separate authorization. Providers must request CCS to issue a separate SAR for medical supplies once the specific non-TAR limit has been reached. A UPN implementation date has not yet been determined.

National Drug Code (NDC) California Department of Health Services (CDHS) recommends the use of Medi-Cal interim codes for physician-administered drugs be discontinued effective for dates of service to be determined by the implementation date of the NDC project. Implementation date is scheduled for September 2008.

Providers would be required to submit both the most specific CPT-4 or HCPCS Level II code and the NDC for physician-administered drugs, with reimbursement based on the NDC. National Drug Code (NDC)

The interim code groups described above are reimbursable to medical professionals such as physicians and physician groups, outpatient providers such as clinics and various hospital outpatient settings, and home infusion providers. National Drug Code (NDC)

The code groups include, but are not limited to, the following categories: Blood factor Chemotherapy Injections Vaccines National Drug Code (NDC)

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