NPI and location question and answer during provider Enrollment

National Provider Identifier (NPI)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the adoption of a standard unique identifier for healthcare providers. The Centers for Medicare and Medicaid Services (CMS) has assigned national provider identifiers (NPIs) to comply with this requirement. NPIs are issued by the National Plan and Provider Enumeration System (NPPES). This one unique number is to be used when filing claims with Blue Cross as well as with federal and state agencies, thus eliminating the need for you to use different identification numbers for each agency or health plan.

To comply with the legislation mentioned above, all covered entities must use their NPI and corresponding taxonomy code, where applicable, when filing claims. All providers who are being credentialed or who are undergoing recredentialing, regardless of network participation, must include their NPI(s) on their application. Claims processing cannot be guaranteed unless you notify Blue Cross of your NPI(s) prior to filing claims using your NPI(s).

What is NPPES? NPPES stands for the National Plan and Provider Enumeration System. The Center for Medicare and Medicaid Services (CMS) has contracted with Cognosante, L.L.C., to serve as the NPI Enumerator.

Organizations that are health care providers must obtain at least one NPI. Corporations are also eligible for subpart NPIs if they are needed to identify components of their business independently from the “parent” organization. If a corporation provides more than one provider type at the same physical location, an additional NPI will be required to identify the additional provider types separately.

How do I get my NPI? For the most efficient processing and receipt of NPIs, use the NPPES web-based application process. Simply log onto the National Plan and Provider Enumeration System (NPPES) at and apply online.

Am I required to have an NPI for my provider type? Yes, unless you are an atypical provider according to NPPES criteria . Then your atypical provider identifier will be your WV Medicaid Provider ID number.

What about NPIs for different locations and different services. How do we register, can we use one NPI? If the different service locations all pay to the same Pay-To, separate NPIs are not required. If you want separate service locations to be their own Pay-To, they must enroll separately, and need to obtain separate NPIs. If you are a provider who has different provider types at the same location, each provider type will be enrolled separately, and need to obtain a separate NPI. You can access more information on subpart enumeration and separate NPIs at the National Plan & Provider Enumeration System (NPPES) at:

Do we need a separate NPI for 2 provider types in the same location?
If you are a provider who has different provider types at the same location, each provider type will be enrolled with a separate Medicaid provider record, and needs to obtain a separate NPI.
I am an individual who is incorporated. Do I need a group NPI and what do I use as a Pay-To NPI? An incorporated individual should obtain a Type 2 Organizational NPI for the corporation in addition to the Type 1 Individual NPI. The Type 2 Organizational NPI will be used as the Pay-To NPI and the Type 1 Individual NPI will be used to enroll the provider in WV Medicaid as a rendering provider to the organization.

My NPI uses a Texas address, what do I do to make sure the NPI address information identifies my service location address in West Virginia? You should go back to the NPI registration site and update your information to your current address. If both of your sites are still active, you will have an opportunity in the WV Medicaid PEAP system to update your address information to the correct address. In any event, your Pay-To address should match the address on your W-9.
I have three optometrists within my practice who have NPIs. Will I need to get NPIs for our opticians as well? Yes, you will revalidate in WV Medicaid as a Vision Center and revalidate the optometrists and opticians as rendering providers using their Type 1 Individual NPIs.

Can the same NPI be used for more than one location?
Yes, if all locations have one Pay-To, a unique identifier will be used to identify the multiple locations. If payment is to be made to the separate locations, each service location should have their own NPI.

I have two locations. Do I enroll/revalidate both offices if I want each office to receive a check?
Yes, in order to receive separate checks, each location would need their own separate Pay-To NPI and would have to be re-enrolled/revalidated in WV Medicaid separately.

I have two offices, one Tax ID with two provider types, and we are incorporated. I want checks sent to each location. Can I enroll once for both? In order to receive checks at each location, you will need to re-enroll/revalidate each location separately with a Pay-To NPI. Since you are incorporated, you qualify to obtain a subpart NPI for your second location. This does not affect your tax ID.

Notifying Blue Cross of your NPI

Once you have been assigned an NPI, please notify us as soon as possible. To do so, you may use one of the following ways:

1. Include it on your Louisiana Standardized Credentialing Application (LSCA), Health Delivery Organization (HDO) Application or Blue Cross recredentialing application.

2. Include it on the online Provider Update Form at >Forms for Providers.

3. Submit it along with your name and tax-ID or social security number printed on your office letterhead by fax to 225-297-2750 or by mail to Blue Cross and Blue Shield of Louisiana; Attn.

Network Administration; P.O. Box 98029; Baton Rouge, LA 70898-9029.

No comments:

Medical Billing Popular Articles