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Certain provider types who bill NYSDOH for services to NYS Medicaid recipients do not have to obtain a National Provider Identifier (NPI) because they are not health care providers as defined in Federal statutes. These providers will continue to use their NYS Medicaid Provider ID and Locator Code in performing their billing and related functions with NYSDOH.
General provider types that do not have to obtain an NPI for billing NYS Medicaid include:
- Child Care Agencies (COS 0122)
- PCPS Capitation Provider (COS 0220)
- Waiver Service (COS 0263)
- HHAS: Vendor Personal Care Services (COS 0264)
- PCS: Personal Emergency Response Services (PERS) (COS 0266)
- OMH Rehab: OMH Rehabilitative Services (COS 0268)
- HHAS: OMR/DD Waiver Services (COS 0269)
- OS: Eyeglass Materials (Upstate) (COS 0408)
- Non Emergency Transportation (COS 0602, 0603, 0604, 0605, 0606, and 0609)
- Bridges to Health Waiver (COS 0124)
Provider types where NPI may be optional include:
- HHAS: Case Management Services (COS 0265) NPI IS NOT required if the rate code is 5210 thru 5214.
- HOS and LTC Health Related Facility (COS 0289 and 0382)
- Acupuncture (COS 0465)
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