Attachment 2 — National Provider Identifier Reference Guide - April 2008 BadgerCare Plus Update 2008-30

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Attachment 2 — National Provider Identifier Reference Guide

These business functions will utilize Medicaid provider numbers until ForwardHealth interChange implementation in October 2008:

Automated Voice Response System.
Contacting Provider Services.
Level of Care Request form (nursing home providers).
Omnibus Budget Reconciliation Act (OBRA) nurse forms.
Paper claim forms.
Paper prior authorization (PA) request forms.
Provider certification and maintenance.
Specialized Transmission Approval Technology-PA (STAT-PA).
Web PA.

On and after May 19, 2008, an NPI and/or a Medicaid provider number will be accepted on standard electronic transactions as detailed below. A provider’s NPI must be on file with BadgerCare Plus prior to indicating an NPI only on transactions.

837 Health Care Claim: Institutional (837I) Billing provider — Medicaid provider number and/or National Provider Identifier (NPI). A taxonomy code, ZIP+4 code, and Contract Information Segment [CN1], if applicable, are required if an NPI is indicated. Attending, admitting, and referring providers* — Medicaid provider number or NPI.	837 Health Care Claim: Professional (837P) Billing provider — Medicaid provider number and/or NPI. A taxonomy code, ZIP+4 code, and CN1, if applicable, are required if an NPI is indicated. Rendering provider — Medicaid provider number and/or NPI with taxonomy code, ZIP+4 code, and CN1, if applicable. Referring provider** — Medicaid provider number or NPI.
837 Health Care Claim: Dental (837D) Billing provider — Medicaid provider number and/or NPI. A taxonomy code and ZIP+4 code are required if an NPI is indicated. Rendering provider** — Medicaid provider number and/or NPI with taxonomy code and ZIP+4 code.	Provider Electronic Solutions Software (PES) Billing provider — Medicaid provider number only or NPI only. The NPI requires a taxonomy code, ZIP+4 code, and CN1, if applicable. Rendering and referring providers — Medicaid provider number or NPI.
National Council for Prescription Drug Programs Telecommunications Standard Format Version 5.1 (NCPDP) Billing provider — Medicaid provider number or NPI. Prescriber ID — Drug Enforcement Agency (DEA) number or NPI.	837I and 837P Automatic Crossovers from Medicare Billing provider with one NPI corresponding to one Medicaid provider number — The NPI that was reported to BadgerCare Plus is indicated in the Billing Provider Secondary Identification element. Billing provider with more than one NPI corresponding to one Medicaid provider number — The secondary NPI is indicated in the Billing Provider Secondary Identification element.
837I Crossover Claims Submitted by Provider Billing provider — Medicaid provider number and/or NPI. A taxonomy code, ZIP+4 code, and CN1, if applicable, are required if an NPI is indicated. Attending, admitting, and referring providers — Medicaid provider number or NPI.	837P Crossover Claims Submitted by the Provider Billing provider — Medicaid provider number and/or NPI. The NPI requires a taxonomy code, ZIP+4 code, and CN1, if applicable. Rendering provider — Medicaid provider number and/or NPI with taxonomy code, ZIP+4 code, and CN1, if applicable. Referring providers** — Medicaid provider number and/or NPI.

* The CN1 is required for hospitals (for services in Attachment 3 of this BadgerCare Plus Update), case management, community support program, comprehensive community service, crisis intervention, day treatment, and prenatal care coordination health care providers only.
** Indicating an NPI for the rendering provider in this instance requires the rendering provider to have an NPI on file with BadgerCare Plus for successful processing.