Wisconsin Medicaid will require all Medicaid-certified health care providers to obtain a National Provider Identifier (NPI) in anticipation of full NPI implementation. The federal Department of Health and Human Services (HHS) adopted the NPI as the standard identifier for health care providers in the Final Rule, published by the HHS. Per the definitions of the Final Rule, Wisconsin Medicaid has identified personal care and specialized medical vehicle providers, blood banks, and Community Care Organizations as non-health care providers; therefore, they are not eligible to obtain an NPI except in the instances detailed in this Wisconsin Medicaid and BadgerCare Update.
General Information
The federal Health Insurance Portability and Accountability Act of 1996 includes provisions requiring the federal Department of Health and Human Services (HHS) to adopt national identification standards for health care providers. The Final Rule published by the HHS adopted the National Provider Identifier (NPI) as the standard identifier for health care providers to replace payer-specific identification numbers. Wisconsin Medicaid will require all health care providers to obtain an NPI. The only exceptions are the providers and instances identified in this Wisconsin Medicaid and BadgerCare Update.
In anticipation of full NPI implementation, Wisconsin Medicaid is now collecting NPIs from health care providers and issuing confirmation letters acknowledging receipt of the NPI submission. Procedures regarding the NPI collection process are detailed in the July 2007 Update (2007-54), titled “Wisconsin Medicaid Is Now Collecting National Provider Identifiers.” Medicaid-certified health care providers will be required to use an NPI to conduct business with Wisconsin Medicaid after NPI is fully implemented.
Providers are encouraged to visit the Centers for Medicare and Medicaid Services Web site at www.cms.hhs.gov/ for additional NPI information or the National Plan and Provider Enumeration System Web site at https://nppes.cms.hhs.gov/NPPES/Welcome.do to obtain an NPI.
National Provider Identifier Exceptions
Per the definitions of the NPI final rule, the following providers have been identified by Wisconsin Medicaid as providers of non-health care services and therefore are not eligible to obtain an NPI:
- Personal care providers.
- Specialized medical vehicle (SMV) providers.
- Blood banks.
- Community Care Organizations (CCOs).
However, if one of these providers has an additional, separate Medicaid certification to provide health care services, an NPI will be required for that certification.
Personal Care Providers
Personal care providers that are Medicaid certified to provide only personal care services should continue to submit their Medicaid provider number on transactions submitted for personal care services. If a personal care provider is Medicaid certified to also provide health care services (e.g., home health), that provider will be required to use an NPI on all transactions once NPI is fully implemented, regardless of whether the claim is for health care services or personal care services.
Specialized Medical Vehicle Providers
Specialized medical vehicle providers should continue to use their Medicaid provider number on transactions submitted for SMV services.
Blood Banks
Blood banks should continue to use their Medicaid provider number on transactions submitted for blood bank services.
Community Care Organizations
Community Care Organizations should continue to use their Medicaid provider number on transactions submitted for CCO services.
