Alabama Medicaid Uses National Provider Identifier
Alabama Medicaid providers have joined other health care providers in the United
States in using a federally-required National
Provider Identifier (NPI) number on all claims
transactions. Use of the NPI is mandated by the
Health Insurance Portability and Accountability
Act (HIPAA) and is also be needed to process
claims a on interChange, Alabama Medicaid’s new claims
processing system.
All Alabama Medicaid providers are required to
submit their NPI information, including taxonomy
codes, to EDS.
Failure to submit NPI information may result in
rejection of a provider's claims.
For more information about obtaining a NPI
number, click here:
https://nppes.cms.hhs.gov/NPPES/Welcome.do
Alabama Medicaid providers can contact EDS for
assistance at 1-800-688-7989 (within
Alabama) or (334) 215-0111 (outside
Alabama).
Important reminder: There is no
charge to get an NPI. Providers can apply
online for their NPI, free of charge, by
visiting https://nppes.cms.hhs.gov or by calling
1-800-465-3203 to request a paper application.
The CMS NPI page, located at
www.cms.hhs.gov/NationalProvIdentStand/, is
the only source for official CMS education and
information on the NPI initiative; all products
located on this site are free of charge.
NPI Information and Forms
for Alabama
Medicaid Providers:
Companion Guide
updates related to the National Provider ID
implementation are now available.
Click here to view and download these documents.
Questions You May Have
About Alabama Medicaid’s Implementation of the
NPI:
What is a National Provider Identifier (NPI)?
The National Provider Identifier (NPI) is
designed to uniquely identify a health care
provider in standard transactions, such as
health care claims. It uses all numeric
characters and is 10 positions in length. The
first nine positions are the identifier and the
last position is a check digit which is used to
detect invalid NPIs.
Why do we need a National Provider
Identifier (NPI)?
The Health Insurance Portability and
Accountability Act (HIPAA) requires that covered
entities (e.g. health plans, health care
clearinghouses, and those health care providers
who transmit any health information in
electronic form in connection with a transaction
for which the Secretary of Health and Human
Services (HHS) has adopted a standard) use NPIs
in standard transactions.
How do I apply for a National Provider
Identification (NPI) number?
There are two ways to apply for a NPI number
from Fox System, Inc., the contractor
responsible for issuing NPI numbers: online or
regular postal mail.
For the most efficient and fastest receipt of
your NPI, the online method is recommended. To
apply online, go to
https://nppes.cms.hhs.gov.
To apply by mail, print the request form from
https://nppes.cms.hhs.gov and send the completed
application to:
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059
Because of the volume of requests expected,
providers are encouraged to apply early and
allow time to receive the number from the
enumerator.
How many numbers do I need to request?
To ensure that reimbursement is not affected by
this change, providers are strongly encouraged
to apply for NPI number(s) based on how their
organization or practice is currently enrolled
in the Alabama Medicaid program. In most cases,
providers should obtain a NPI for each provider
number they currently have. Large or complex
organizations may want to contact their EDS
Provider Representative for assistance before
requesting numbers.
Note: All providers requesting a NPI
number must also request at least one taxonomy
code. Provider taxonomy codes are an
administrative code set identifying a provider
type and area of specialization for all health
care providers. A given provider may have up to
five taxonomy codes, depending on their
specialty areas. Any taxonomy codes received
should be provided to EDS along with the NPI
number.
What do I do once I receive my NPI number(s)?
Once the NPI number and any taxonomy codes are
received, they should be submitted to EDS using
the NPI Notification Form available from EDS.
EDS is now ready to receive this information.
Providers will need to send 1) The completed NPI
Notification Form, and 2) a copy of the NPI
notification letter received from the enumerator
to EDS. The documents can be mailed to the
address on the form or faxed to the number
indicated on the form. A copy of the
Notification Form is also available on the
Alabama Medicaid website at
www.medicaid.alabama.gov under
Billing/Forms/Provider Enrollment Forms.
Note: Providers will continue to submit
claims with their current Alabama
Medicaid-issued provider numbers until the new
system to accommodate NPI numbers is implemented
on February 25, 2008.
What if I have other questions about NPI?
If you have questions regarding how to fill out
the NPI Notification Form, contact your Provider
Representative at 1-800-688-7989 (within
Alabama) or (334) 215-0111 (outside Alabama).
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