National Provider Identifier (NPI) Information
Get It! Share It! Use It!
Getting one is free -
Not having one can be costly!
Effective May 23, 2008, all claims must contain your NPI and taxonomy.
N.C. Medicaid will no longer accept claims submitted without an NPI on or after May 23, 2008. Unless
you are an atypical provider, failure to use the NPI by this date
will result in a claim denial.
All claims should
contain the following information:
National Provider Identifier
- Billing provider
- Attending provider, if applicable
- Referring provider, if applicable
Medicaid Provider Number (optional after May 22, 2008)
- Billing provider
- Attending provider, if applicable
- Referring provider, if applicable
Taxonomy Code
For all claims (except pharmacy) that are submitted electronically,
a taxonomy code must be included for the billing provider. However,
if the procedure or service is billed with an attending provider number,
only the taxonomy code for the attending provider is included on the electronic
claim submission. For paper claims, a taxonomy code for the both
the billing provider and, if applicable, the attending provider must be
included on the claim.
Note: Pharmacy providers must submit claims with their NPI
number and the prescriber’s NPI number or DEA number entered on the claim.
For placement of data on the 837 transaction, consult the X12
Implementation Guide. The NCECSWeb tool now contains fields to
report this information. For CMS-1500, UB-04, and ADA claim forms,
consult the June 2007 Special Bulletin, New
Claim Form Instructions.
DMA encourages all providers (except pharmacies and atypical providers) to continue to submit their National Provider Identifier (NPI), Medicaid Provider Number (MPN), and taxonomy on all claims until they receive an NPI Provider Ready letter confirming that their claims are mapping correctly to the MPN submitted on the claim. DMA began mailing the NPI Provider Ready letters to providers on May 16, 2008. After receiving the letter, providers may begin submitting claims without their MPN.
Refer to future general Medicaid bulletins for additional information on the Provider Ready letters.
NPI and Address Database
The NPI and Address Database lists the NPI and addresses of active NC Medicaid providers (or providers who have been end-dated within the past 12 months).
To check to see if DMA has your correct NPI and address on file, search the NPI and Address Database.
If you have still have not reported your NPI to DMA, search the NPI and Address Database for your provider number and follow the instructions on the results screen
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