Medicaid in Education Alert
New York State Office of Health Insurance Programs (NYS OHIP)
New York State Education Department (NYSED)
Preschool/School Supportive Health Services Program (SSHSP)
Medicaid in Education Units

Issue #11-03

To: All SSHSP Medicaid Providers
From: NYS DOH OHIP SSHSP &
NYSED Medicaid in Education Unit
Date: September 12, 2011
Subject: Medicaid National Provider Identifier (NPI) Requirements

It is a federal requirement that a National Provider Identifier (NPI) be included on all claims submitted for Medicaid reimbursement. Currently only the billing provider’s NPI is required on school supportive health services claims. Effective January 1, 2012, school supportive health service claims submitted to Medicaid for reimbursement must contain both the billing provider’s NPI and the attending provider’s NPI. The attending provider is the clinician who has overall responsibility for the student’s medical care. The servicing provider is the clinician that provides services to the student on a regular basis. In cases where the servicing provider works “under the direction of” or under the supervision of a licensed clinician, the directing/supervising clinician is considered the “attending” clinician. For purposes of reporting NPI numbers on SSHSP Medicaid claims, the attending provider’s NPI number must be used where the attending provider and the servicing provider are not the same individual. NPIs for billing providers and attending providers must be registered with the New York State Medicaid program before being included on a claim. School districts, counties, and §4201 schools are responsible for registering the NPIs of their affiliated providers with the New York State Medicaid program before January 1, 2012.

The New York State Medicaid program offers two methods for registering affiliated providers’ NPIs:

  • At the eMedNY website,
  • Via a batch process by following the instructions in the Facilities Practitioner’s NPI Reporting (batch reference guide) located on the NYHIPAADESK home page under NPI.

School districts, counties, and § 4201 schools with a large number of practitioners are encouraged to maintain a “roster” of their providers’ NPIs. As changes are made to the roster, please forward updated lists to the New York State Medicaid program using the batch facilities method found at eMedNY website (PDF) .

Duplicate posting of practitioners’ NPIs will not create a problem. For questions and concerns regarding Facility Affiliated Practitioner NPI Reporting, please contact the eMedNY Call Center at (800) 343-9000.

Special transportation claims will not require a servicing provider NPI. Special transportation claims will continue to be submitted with only the billing provider’s NPI.

For SSHSP purposes, the billing provider is the school district, county, or §4201 school. The attending provider is the individual who has overall responsibility for the student’s medical care and treatment. Therefore, servicing practitioners operating under the direction of or under the supervision of another practitioner must use their supervisor’s NPI (i.e., the NPI of the attending provider) on SSHSP claims. This applies to occupational and physical therapy assistants, licensed practical nurses and licensed master social workers (LMSWs), even though they may have an individual NPI.

For SSHSP purposes, beginning January 1, 2012, the following licensed, registered, and/or certified as appropriate attending providers’ NPIs must be reported on SSHSP claims:

  • speech-language pathologists;
  • physical therapists;
  • occupational therapists;
  • psychologists;
  • psychiatrists;
  • clinical social workers;
  • registered professional nurses;
  • audiologists; and,
  • physicians, physician assistants, or nurse practitioners.

For SSHSP purposes, the following service providers are required to report their supervisor’s (the attending practitioner’s) NPI:

  • certified teachers of the speech and hearing handicapped;
  • certified teachers of students with speech and language disabilities;
  • physical therapy assistants;
  • occupational therapy assistants;
  • licensed master social workers; and
  • licensed practical nurses..

At this time, the ordering/referring provider’s NPI is not required on SSHSP claims. However, school districts, counties, and §4201 schools are not precluded from reporting the ordering/referring provider’s NPI in addition to those of the billing and attending provider.

School districts, counties, and §4201 schools should ensure affiliated providers have NPIs. Providers required to report an NPI should be encouraged to obtain NPIs as soon as possible. Once practitioners have NPIs, school districts, counties, and §4201 schools must register them with the New York State Medicaid program. Failure to complete this process prior to January 1, 2012 could result in a lag in payment or the denial of SSHSP claims.

A list of National Provider Identifier (NPI) questions and answers is attached for quick reference. Topics covered include how to obtain an NPI, where to get additional information about NPIs and how NPIs are used.

If you have any questions or comments regarding this alert, please contact your local Regional Information Center representative or the NYS Education Department, Medicaid Unit at medined@nysed.gov.

Last Updated: November 15, 2021