Issue #12-02

Medicaid Alert 11-03 informed school districts, counties, and §4201 schools that they must include the NPI of the attending provider on SSHSP Medicaid claims for dates of service on and after January 1, 2012.

NPIs for billing providers (school districts, counties, and §4201 schools) and attending providers must be registered with the New York State Medicaid program before being included on Medicaid claims submitted via eMedNY for reimbursement. School districts, counties, and §4201 schools are responsible for registering the NPIs of their attending providers with the New York State Medicaid program before claims for dates of service January 1, 2012 and later are submitted. For dates of service January 1, 2012 and later, Medicaid claims without a registered NPI will not be paid. Claims for services rendered prior to January 1, 2012 may still be submitted without an associated attending provider NPI.

School districts, counties, and §4201 schools may access directions on how to affiliate (register) NPIs on the eMedNY.org website. Directions are located in the self help section of the website and links have been provided below. SSHSP providers (school districts, counties, and §4201 schools) should review the appropriate instruction manual and refer any questions regarding the process to eMedNY at 1-800-343-9000 (select option #3 for clinic, then select option #4 for billing).

Once the affiliation process is completed, it generally takes up to 24 hrs for the system to update.

Facilities Practitioner’s NPI Reporting (PDF Web Instructions)

Facilities Practitioner’s NPI Reporting (PDF Batch Instructions)

It has come to our attention that individuals cannot add or use a group taxonomy code on their NPI registry file. Those practitioners who already have an individual NPI do not need to add another taxonomy code. If obtaining an NPI for the first time, it is recommended that practitioners select an individual taxonomy code, not a group taxonomy code. This guidance supersedes Q+A #3 that was issued with MA Alert 11-03.

Items to note when registering NPIs:

1. Practitioners must register/affiliate their NPI with each SSHSP provider (school district, county, and §4201 school) that may submit a Medicaid claim for services they have rendered.
2. License numbers must be 8 characters (if less than 8 characters, add preceding zero(es)). If the license number has a -1 at the end of it, do not include it. If the license number has the Profession Code in front of it, do not include it.
3. Practitioners and/or SSSHP providers can look up individual license information on the Education Department’s Office of Professions webpage.
4. A school district, county, or §4201 school federal employment identification number (FEIN is the tax identification number) can be obtained from the school district, county, or §4201 school business office.
5. The school district, county, or §4201 school NPI is NOT the same as a Medicaid provider number. NPIs are 10 digits in length.
6. This NPI registration/affiliation process is an ongoing one. School districts, counties, and §4201schools must register newly hired attending provider NPIs with eMedNY and must deactivate attending providers that separate from service.

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.