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Elizabeth M. Whitehorn, Director

Provider Notice Issued 07/18/2019

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Date:    July 18, 2019

 

To:       Institutional Providers – Hospitals; Renal Dialysis Facilities; Ambulatory Surgical Treatment Centers; Hospice Agencies; and Birth Centers

 

Re:      Attending Provider NPI Requirements for October 1, 2019

 

 

This notice informs providers that bill on the UB-04 or 837I claim formats of new edits regarding the Attending Provider NPI.

 

The Attending Provider NPI field is required for all institutional claims, and the Department already edits claims to ensure the Attending Provider NPI is valid. As a result of a federal audit finding, the Department will implement two new edits to ensure that the Attending Provider is an individual and enrolled.   

 

Effective with dates of service on and after October 1, 2019, the Department will reject claims if the Attending Provider is not enrolled with the Department. Any provider not enrolled must go to the IMPACT webpage to start the enrollment process.

 

Claims with dates of service prior to October 1, 2019 will receive the following informational messages, if the Attending Provider NPI does not pass HFS editing:

 

I52 – Attending NPI Must be an Individual

 

I53 – Attending NPI Not Enrolled

 

Claims with dates of service beginning October 1, 2019 will receive rejections based on those same errors. 

 

Questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 877-782-5565.

 

 

Doug Elwell

Medicaid Director