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Frequently Asked Questions (FAQs) for eMedNY HIPAA Support

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Q.

NPI, National Provider Identifier – How can I tell if I need to get an NPI for NYS Medicaid billing?

 

 

Category: Provider

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Published: 11/03/2011

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Updated: 05/27/2014

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QID: PR05

 
 

A.

Certain provider types (as defined by either Category of Service (COS) or Rate Code) who bill NYSDOH for services to NYS Medicaid beneficiaries do not have to obtain a National Provider Identifier (NPI) because they are not health care providers as defined in Federal statutes. These providers are known as "Atypical" providers. These providers need to continue to use their NYS Medicaid Provider ID and Locator Code in performing their billing and related functions with NYSDOH.

As of October 1, 2009, Atypical providers who submit transactions with an NPI will experience denials of both claim and non-claim (MEVS) transactions.

General provider types that do not have to obtain an NPI for billing NYS Medicaid include:

  • ALP - Assisted Living Program (COS 0267)
    PCPS Capitation Provider (COS 0220)
    Waiver Service (COS 0263)
    HHAS: Vendor Personal Care Services (COS 0264)
    PCS: Personal Emergency Response Services (PERS) (COS 0266)
    HHAS: OPWDD (previously OMRDD) 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.

Questions about Medicaid Billing should be directed to the eMedNY Call Center at 1-800-343-9000.

 
 
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