Vendor FAQ
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GENERAL
1. How will Georgia Medicaid implement NPI?
Georgia Medicaid will comply with federal regulations and begin using the National Provider (NPI) as the provider identifier on all standard electronic transactions on or prior to May 23, 2007.
The Medicaid Provider ID will continue to be used for all internal activities and reporting, and will still be used in external operational and system activities that are not standard transactions.
A crosswalk will be built between current provider Medicaid IDs and NPI. In order to build this crosswalk in an effective and timely manner we have already begun collecting NPIs from providers. As part of this process we have asked all providers to submit their NPIs on a specific form where they match their NPI(s) to their current Medicaid Provider ID(s) and also provide the appropriate taxonomy code(s) for the NPI submitted. While we can encourage providers to obtain an NPI for each of their Medicaid Provider IDs we cannot require them to do so.
Georgia Medicaid will be using a solution which will cross match an NPI submitted in an electronic transaction to the appropriate Medicaid Provider ID. This solution will go through a series of steps to match information from a claim or other standard electronic transaction to the correct provider. Some of these matching steps include:
- Match to cross-walk table
- Name match
- Zip code match
- Taxonomy code match
- Tax payer ID match
Using this matching process we expect to be able to match 99% of submitted electronic claims to the correct provider. The remaining claims that cannot be matched using this system process will be sent to a file to be matched manually.
Other provider-based activities will continue to be managed with the Provider Medicaid ID. These activities include:
- Paper claims submissions
- Resubmission of electronic claims on paper
- IVR system inquiries
- Telephone inquiries
- Prior authorizations
- Referrals
- Other Medicaid forms
2. What has been communicated to providers about NPI requirements for Georgia Medicaid?
Georgia Medicaid has distributed communications to providers and provider organizations detailing NPI expectations and plans for Georgia Medicaid. Providers have been asked to submit their NPI(s) by December 31, 2006. Please see the document titled “NPI Submittal Instructions” under Documents and Forms in the Provider Information section of the GHP web portal for additional information on what has been communicated to providers.
3. Will Georgia Medicaid require NPI on paper claims?
No. NPI will be used only for standard electronic transactions.
4. Will all Medicaid providers be required to have an NPI?
No. Providers who meet either of the two criteria below will not be required to have an NPI and will continue to use the Georgia Medicaid Provider ID they are assigned.
- Providers who submit only paper claims.
- Providers who are considered atypical providers. For a list of provider types and categories of service and the associated NPI requirements for Georgia Medicaid see the document titled “NPI Submittal Instructions” under Documents and Forms in the Provider Information section of the GHP web portal.
5. Will Georgia Medicaid continue to assign provider IDs to all Medicaid providers?
Yes. Medicaid IDs will continue to be used for all activities other than standard electronic transactions.
6. Does Georgia Medicaid plan on consolidating IDs for Medicaid providers currently assigned multiple IDs?
No. We are encouraging providers to enumerate with NPI in the same way they are currently assigned Medicaid IDs. Claims for providers who do not enumerate in this way will be matched to legacy IDs as described under “How will Georgia Medicaid Implement NPI?”
CMO FAQs
Provider Files
1. Will DCH pass the NPI as part of the provider file regularly sent to the CMOs?
Yes. The NPI is already included in the monthly provider file (7400). Taxonomy codes will be added to the provider file. The CMOs should verify the NPI received in the provider file with any they have on file and resolve any discrepancies.
2. Will DCH use taxonomy codes with NPI?
Yes. We have asked providers to submit their taxonomy code(s) when they submit their NPI(s). The taxonomy codes will be used as part of the cross match process.
3. Will NPIs be submitted to Maximus in the weekly provider directory file?
Yes. Both the NPI and Medicaid provider ID need to be submitted to Maximus in the weekly provider directory file.
Enrollment Files
1. Will DCH send NPIs and taxonomy codes on the daily/monthly enrollment (834) files?
NPIs will be sent on the 534 files.
2. When will the 834 companion guide be available?
An updated 834 companion guide can be expected after January 2007.
Encounter Transactions
1. Will DCH require the NPI on encounter transactions?
Yes. The encounter transaction (837) is a standard electronic transaction and requires the NPI to be used after May 23, 2007. NPIs and taxonomy information will be required for all provider types where a Medicaid provider ID is currently required. Medicaid provider IDs will continue to be used for atypical providers. This includes the Payee (MCO), Billing, Rendering, Referring and Attending provider types for the 837 formats. NCPDP transactions only require NPI for the pharmacy and prescribing provider types.
2. Will DCH need the Provider Medicaid ID to be returned on encounter transactions?
After 5/23/07 the Provider Medicaid ID should not be returned on encounter transactions. There will be a dual submission testing from February to May 23, 2007 during which the NPI and Provider Medicaid ID should be submitted.
3. Will DCH support dual submission on all transactions and return dual submission on all responses?
Yes the state will support dual submission and return dual submission on all transactions during the dual submission period (February – May 23, 2007).
4. Will DCH want the NPI as the primary identifier or secondary identifier during the dual submission period?
During the dual submission period the NPI should be submitted as the primary identifier (elements NM108/NM109). The provider Medicaid ID and tax ID should be submitted as secondary identifiers located in the REF segments.
5. Will DCH need the taxonomy code to be reported on encounter transactions?
Yes. The taxonomy code should be returned on encounter transaction. The taxonomy code on the transaction should match the taxonomy code on file for the provider.
6. Will there be any problem mixing transactions for atypical and typical providers?
The CMOs will be able to mix transaction for atypical and typical providers in batch submissions. The NM108 and NM109 elements should be populated correctly identifying the number as an NPI number or Medicaid provider number.
7. Can the CMOs request the provider’s tax ID on claims?
Yes. DCH is also requesting the tax ID on claims. The tax ID will be used as part of the cross-match process.
Payment Files
1. Will DCH send an NPI for the MCO identifier on the on the weekly/monthly payment files?
Yes.
2. When will a revised 835 Companion Guide e available?
A revised 83 Companion Guide will be avail able after January 2007.
Other
1. Will DCH expect the CMOs to use the NPI on their IVRs and for Web portal processing?
The NPI should be available for all screens the provider uses for Web portal processing. There are no specific requirements for IVRs.
2. Does the State use any proprietary transactions that will require NPI?
No. All transactions conducted with the CMOs are standard X12 transactions.
3. Will DCH need the Provider Medicaid ID to be used on reports?
Reports resulting from standard transactions should include the NPI as the provider identifier except for atypical providers who retain their Medicaid IDs.
4. When will DCH conduct testing?
Testing will be conducted February – May 2007.
5. When will information be available on testing protocols for all transactions?
Information on testing protocols will be available by the end of December 2006.