The California Department of Health Services (DHS) recently announced that Medi-Cal has extended its National Provider Identifier (NPI) registration deadline to May 23. And to ease the transition, Medi-Cal will implement on May 23 a “dual use” period, during which physicians will be encouraged to use both their Medi-Cal provider numbers and their NPIs (if available) on Medi-Cal claim forms. During this transition period, NPI use is encouraged but not required for adjudication. Physicians must, however, continue to use their Medi-Cal provider numbers until instructed otherwise. More information will be published in Medi-Cal’s March Provider Update.

Medi-Cal will on April 23 begin accepting the new universal claim forms (CMS 1500 for physicians, UB 04 for institutions). On June 25, Medi-Cal will no longer accept claims on the old forms (HCFA 1500/UB 92). Between April 23 and June 25, providers are encouraged to migrate their business processes away from the HCFA 1500 and UB 92 and deplete their form stock in preparation for exclusive use of the new forms. Providers may choose to fully transition to the new claim forms at any time during this two-month window.

This delay applies only to Medi-Cal and does not mean that physicians can put off applying for an NPI. On May 24, claims sumbitted to Medicare and private payors will be denied if submitted without an NPI. This is not an idle threat. Physicians will have had two full years to get their NPIs.

Applying for an NPI is fairly simple. Physicians can apply online at https://nppes.cms.hhs.gov. If you do not have Internet access, call the NPI Enumerator at 800/465-3203 and request a paper application form.

While applying for an NPI is straightforward, making sure your billing systems and vendors are ready for the transition is a more complicated process, one that requires some preparation and internal assessment. CMA’s HIPAA partner, PrivaPlan, has developed an inexpensive CD-ROM toolkit to help physicians navigate the process.

If you haven’t investigated it, you should give it a look. The toolkit will help physicians understand their NPI “readiness” and the impact the NPI may have on their practices. It also provides form letters and surveys to send to your major system vendors, clearinghouses, and health plans, to determine their NPI readiness.

CMA members can purchase the toolkit for $99. CMA members who have purchased PrivaPlan’s other HIPAA toolkits pay $79. Nonmembers pay $129. Order the toolkit by calling 877/218-7707.

CMA’s legal department has also written a primer to help physicians with the NPI process. The primer, available through the CMA ON-CALL system, is available free to members at the members-only website. See document #1608, “National Provider Identifiers.” Nonmembers can purchase ON-CALL documents for $2 per page in the CMA bookstore.

Contact: CMA’s reimbursement help line, 888/401-5911.