Provider Notice issued 11/15/10

National Provider Identifier (NPI) Reporting

The Department of Healthcare and Family Services (HFS) and the Department of Human Services, Division of Mental Health (DHS/DMH) have joined forces to implement a direct claim submittal process for community mental health services—both Medicaid and non-Medicaid services—reimbursed through DHS. The purpose of this notice is to provide the information necessary to submit claims electronically to HFS directly on or prior to July 1, 2011, in accordance with Public Act 096-1405.

This initiative will require all community mental health (CMH) providers to obtain a unique National Provider Identifier (NPI) for each HFS provider number and each 16-digit payee number. This is to ensure that providers do not experience rejection of claims, delays in claims processing or denial of payment. The one NPI to one HFS provider number, and one NPI to one HFS 16-digit payee number, are required to accommodate the HFS claims processing system, thus assuring no duplication of payment for the same service.

Billing Provider NPI Reporting

To assist providers in this process, HFS has generated Provider Information Sheets to help CMH providers and payees identify their HFS Provider Numbers and their designated Payee information. Once NPI(s) are attained and this task is completed, CMH providers will have a unique NPI Provider Number for each site. To assure compliance with this initiative, providers will be required to report their NPIs to HFS prior to billing with their NPI(s). Effective with claims received on or after April 1, 2011, NPIs registered in compliance with this notice will be required for all claim submittals.

Pay-To Provider (Payee) NPI Reporting – Provider Information Sheets

The 16-digit payee number may be identified on the Provider Information Sheet generated by HFS. It consists of the nine-digit federal employer identification number (FEIN), the five-digit zip code and a two-digit vendor identification number for the designated payee. Providers have the option of consolidating all active payee numbers into one single payee number. Providers who would like to consolidate their payees should contact HFS' Provider Participation Unit at 217-782-0538.

Providers must use the following procedure to report their NPIs:

• Fax the provider or payee approval letter from the National Payee/Provider Enumeration System (NPPES) with the CMH provider contact name and phone number to 217-557-8800.

An additional notification will follow later this fall to provide information on fee-for-service billing training that HFS and DHS/DMH will be conducting. Questions regarding this notice may be directed to the HFS Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa Eagleson, Administrator

HFS, Division of Medical Programs

Lorrie Rickman-Jones, Ph.D., Director

DHS, Division of Mental Health