Alert 06-2


New York State, Office of the Medicaid Inspector General (NYS OMIG)

School/Preschool Supportive Health Services Program (SSHSP/PSHSP)

Medicaid in Education Unit

Issue #06-2

TO: All SSHSP/PSHSP Medicaid Providers

FROM: NYS OMIG SSHSP/PSHSP Medicaid in Education Unit

DATE: September 22, 2006

SUBJECT: National Provider Identifier (NPI)

This alert is to inform all SSHSP/PSHSP providers of the upcoming federal NPI requirement.

In May, 2005, the Centers for Medicare and Medicaid Services (CMS) released its initiative to create a new identifier for use in all standard electronic health care transactions. The National Provider Identifier (NPI) number (10 digits) will be required in conjunction with the current NYS Medicaid Provider number (8-digits) for which NYS school districts, counties, and 4201 schools now utilize for Federal Medicaid reimbursement. This change is due to the implementation of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and will take effect May 23, 2007.

School districts, counties, 4201 schools currently utilize their Medicaid Provider Identification Number (PID) to submit files for Medicaid reimbursement. While this Medicaid number will still be used by the State, all providers will be required to apply for and be issued an NPI number in order to have their claims processed for Federal Medicaid reimbursement as of the May 23, 2007 deadline. It is anticipated that NPI application instructions for the SSHS/PSHS programs will be sent to the school districts, counties, and 4201 schools in October 2006. At this time, the State is only alerting our program providers of this upcoming requirement. Please note that failure of a SSHSP/PSHSP provider to obtain a NPI by the May 23, 2007 deadline will result in the suspension of their eligibility to have claims processed for Medicaid reimbursement.

For any questions/comments regarding this alert, please contact your New York State Office of the Medicaid Inspector General, Medicaid in Education Unit representative.

Last Updated: June 5, 2009