NPI Required on Electronic Transactions Beginning May 23
Magellan will require providers to submit their National Provider Identifier (NPI) on all HIPAA-standard electronic transactions beginning May 23, 2008. This is the date that the Centers for Medicare & Medicaid Services’ (CMS) one-year contingency period (or “grace” period) ends. All standard electronic transactions received without NPIs will be rejected.
NPI numbers replace all government-issued identifiers, Medicaid PINs and Medicare UPINs (as well as Magellan-assigned MIS numbers) on HIPAA-standard electronic transactions, including provider claims submitted electronically. Taxpayer Identification Numbers (TINs) continue to be required on all claims – both paper and electronic.
Because payment is calculated at the individual practitioner level (i.e., psychiatrists, psychologists, social workers, master’s-prepared therapists and clinical nurse specialists/nurse practitioners) for CPT-based services, groups and organizations should submit Type 1 professional NPIs for rendering providers, along with their group practice/organization Type 2 NPIs, according to the following instructions:
- For claims submitted via the ASC X12N 837 professional health care claim transaction, place the Type 2 NPI in the provider billing segment, loop 2010AA; place the Type 1 NPI in loop 2310B.
- On the CMS-1500 form (version 08/05), insert billing Type 2 NPI in Box 33a; insert service facility Type 2 NPI (if different from billing NPI) in Box 32a; insert Type 1 NPIs for rendering providers in Box 24J.
- On the UB-04 form, insert the main Type 2 NPI in Box 56; insert Type 1 NPIs for rendering providers in boxes 76 – 79.
If you have not yet submitted your NPI for inclusion in our records, please do so immediately by:
- Signing in to this provider website using your secure username and password
- Clicking Display/Edit Practice Information in the left-hand menu
- Completing the NPI field.
You also can submit your NPI by faxing your NPI notification letter or e-mail from the National Plan and Provider Enumeration System (NPPES) to Magellan at 314-387-5584.
To apply for your NPI, call 1-800-465-3203 or e-mail to request a paper application. For the fastest receipt of your NPI, you should apply online at https://nppes.cms.hhs.gov.
Once you have obtained and submitted your NPI to Magellan, include this number on all claims that you submit to us. With the close of the contingency period, CMS expects all providers to comply with the NPI initiative, and Magellan hopes to avoid rejecting providers’ electronic transactions.
For an overview and additional information on NPI, visit the CMS website. Magellan also has posted Frequently Asked Questions about NPI on this website. Our NPI Claims Tips provide specific details on how to prepare and submit HIPAA-compliant claims.