|
National Provider Identifier
Getting an NPI is free; not having one can be costly.
___________________________________________________________________________________ Learn more about NPI
This tutorial (in PowerPoint and PDF) provides an overview of NPI requirements and how providers and submitters must use the NPI in when billing DHS for health-care-related services.
Apply for your NPI with NPPES
To get an NPI, apply online at the National Plan and Provider Enumeration System (NPPES) Web site, free of charge. You can also call 800-465-3203 to request a paper application.
Register your NPI with DHS
All providers of health-care-related services with a current 6- or 9-digit Oregon DHS provider number must provide DHS with their 10-digit NPI and related taxonomy. To register your NPI with DHS, complete the NPI Registration Form (PDF) and return it to DMAP Provider Enrollment.
Use NPIs on all electronic transactions submitted to DHS
If you are required to use an NPI, you must send electronic transactions to include your NPI. DHS is NPI-compliant for all transactions.
- If you send DHS a claims transaction (837I 837P, 837D, or NCPDP) with a non-NPI identifier in any of the provider fields, your claim will deny for payment; other transactions may not process.
- Refer to the DHS Companion Guides for specific information on where to enter your NPI(s) for each transaction exchanged with DHS.
Billing Provider ID
|
If your billing software is set up to send both the NPI and the non-NPI identifier(s), and your clearinghouse or billing service will not be stripping the legacy identifier from your claim, you must do one of the following:
- Make sure to strip and submit the electronic claim with NPI only (i.e., with NO legacy identifiers), or
- Submit the claim on paper.
|
Secondary Provider ID
|
If you have to supply secondary provider information (e.g., the ordering/ referring/ attending/operating provider, service facility location, or prescriber) and do not furnish an NPI in the secondary provider field, you must attempt to obtain that NPI in order to enter it on the claim.
The billing provider may use the NPI Registry or directly contact the secondary provider to obtain the NPI.
DHS will follow Medicare’s process as follows, when you have exhausted all possibilities of finding the NPI and still cannot find the NPI:
- For referring, rendering or prescribing provider loop: The billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) can use their own NPI here.
- For service facility location loop: Do not report an identifier in this loop.
|
NPI Progress Reports
DHS status on NPI implementation (PDF) - Information updated 12/12/2007
|
