When a facility has two provider numbers, how is Medi-Cal going to determine between them when both have the same taxonomy code?
The claims payment system will use data contained on the claim to accurately adjudicate the claim. • For Federally Qualified Health Centers (FQHCs), how will the claims processing system know how to pay Evaluation and Management (E & M) using code 01 when the NPI is used on the claim instead of the Medi-Cal provider number with a FQHC prefix? A: FQHC E&M code 01 is specific to FQHC providers; therefore, the appropriate payment for FQHC providers will result. FQHC payment outcomes, however, are subject to variance by location due to differing negotiated rates by location. In the event an FQHC location meets the test of a covered entity in context to the NPI final rule (i.e., conducts HIPAA standard transactions such as eligibility, claims, etc.), that separate location must identify itself using a unique NPI subpart. • If an organization did not apply for subpart NPIs for their multiple Medi-Cal provider numbers, how will Medi-Cal process claims under one NPI without the provider inform
