What happens when a provider has several NPIs used for Medicare and does not register all of them with Medi-Cal?
Medicare claims that crossover without an NPI registered with Medi-Cal will not be processed. The NPI used for billing Medicare must be the same NPI registered with Medi-Cal. The intent of the NPI regulation is to use only one NPI when billing several payers or programs as opposed to obtaining and registering separate NPIs for each payer, program and/or location. Providers that enumerated at a payer, program or location level and use different NPIs to bill for the same types of services may want to reconsider that practice. The next Transaction and Code Set standards (version 5010) scheduled to become a regulation requires that providers use one NPI for the same types of services billed to all payers instead if being optional for the 4010A1 transaction. This means providers that elected to enumerate differently from payer to payer will be required to make changes when Medi-Cal implements version 5010. Therefore, it may be in the provider’s best interest to evaluate their enumeration pr