Issue #24-06

The purpose of this Alert is to remind SSHSP providers of the National Provider Identifier (NPI) Medicaid claiming requirements. SSHSP Medicaid claims must contain the NPI of the Medicaid-enrolled billing provider, Medicaid-enrolled ordering/referring provider, and the affiliated licensed attending provider.

Providers must not submit claims without NPIs unless specifically directed to do so.

Billing providers (school districts and counties) and licensed ordering/referring providers must be enrolled with the New York State Medicaid program before being included on Medicaid claims submitted via eMedNY for reimbursement for eligible services. School districts and counties are responsible for affiliating the NPIs of their attending providers with the New York State Medicaid program before claims are submitted.

For more information on NPI reporting requirements on SSHSP Medicaid claims please review Medicaid Alerts:

Medicaid Alert 11-03 Medicaid National Provider Identifier (NPI) Requirements

Medicaid Alert 12-02 Additional Information on the National Provider Identifier (NPI) Requirements for SSHSP

Medicaid Alert 13-04 Requirement to Report Ordering/Referring Provider’s National Provider Identifier (NPI) on SSHSP Medicaid Claims

Medicaid Alert 13-07 NYS Medicaid provider enrollment requirement for providers who order/refer in the SSHS program.

Medicaid Alert 14-01 Resolving eMedNY Attending Provider National Provider Identifier (NPI) Affiliation Errors

Medicaid Alert 19-03 eMedNY modification for SSHSP attending provider claim editing.

If you have any questions or comments regarding this alert, please contact the DOH at (518) 473-2160 or at SSHSP@health.ny.gov, the NYS Education Department, Medicaid Unit at medined@nysed.gov.