The California Department of Health Services (DHS) recently announced that Medi-Cal has extended its National Provider Identifier (NPI) registration deadline to November 25. Medi-Cal recently implemented a “dual use” period, during which physicians are 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.

This delay applies only to Medi-Cal and does not mean that physicians can put off applying for an NPI. As you know, the Centers for Medicare & Medicaid Services (CMS) recently announced a one-year grace period during which physicians will not be penalized for noncompliance as long as they have a contingency plan in place and are able to demonstrate “good faith efforts” to comply with the NPI regulations. However, to prove good faith, you must obtain your NPI as soon as possible. Since there are very few barriers to obtaining an NPI (it is a simple application), few physicians can argue that they need a contingency plan.

This delay does not affect paper claims. Effective this week, Medi-Cal will only accept the new universal claim forms (CMS 1500 for physicians, UB 04 for institutions). Claims submitted on old forms (HCFA 1500/UB 92) will be denied.

Physicians replacing multiple provider numbers (i.e. Medi-Cal and CHDP) with one NPI, should be aware that the “pay-to” address, EFT account, and PIN of the first legacy number entered during the Medi-cal NPI registration process will, by default, transfer to the new provider record.

Click here to read the Medi-Cal announcement on this issue.

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