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National Provider Identifier (NPI) Number

Alabama Medicaid Uses National Provider Identifier

Alabama Medicaid providers have joined other health care providers in the United States in using a federally-required National Provider Identifier (NPI) number on all claims transactions. Use of the NPI is mandated by the Health Insurance Portability and Accountability Act (HIPAA) and is also be needed to process claims a on interChange, Alabama Medicaid’s new claims processing system.

All Alabama Medicaid providers are required to submit their NPI information, including taxonomy codes, to EDS. Failure to submit NPI information may result in rejection of a provider's claims. 

For more information about obtaining a NPI number, click here: https://nppes.cms.hhs.gov/NPPES/Welcome.do

Alabama Medicaid providers can contact EDS for assistance at 1-800-688-7989 (within Alabama) or (334) 215-0111 (outside Alabama).

Important reminder: There is no charge to get an NPI. Providers can apply online for their NPI, free of charge, by visiting https://nppes.cms.hhs.gov or by calling 1-800-465-3203 to request a paper application. The CMS NPI page, located at www.cms.hhs.gov/NationalProvIdentStand/, is the only source for official CMS education and information on the NPI initiative; all products located on this site are free of charge.


NPI Information and Forms for Alabama Medicaid Providers:

Companion Guide updates related to the National Provider ID implementation are now available.
Click here to view and download these documents. 


Questions You May Have About Alabama Medicaid’s Implementation of the NPI:

What is a National Provider Identifier (NPI)?
The National Provider Identifier (NPI) is designed to uniquely identify a health care provider in standard transactions, such as health care claims. It uses all numeric characters and is 10 positions in length. The first nine positions are the identifier and the last position is a check digit which is used to detect invalid NPIs.

Why do we need a National Provider Identifier (NPI)?
The Health Insurance Portability and Accountability Act (HIPAA) requires that covered entities (e.g. health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services (HHS) has adopted a standard) use NPIs in standard transactions.

How do I apply for a National Provider Identification (NPI) number?
There are two ways to apply for a NPI number from Fox System, Inc., the contractor responsible for issuing NPI numbers: online or regular postal mail.

For the most efficient and fastest receipt of your NPI, the online method is recommended. To apply online, go to https://nppes.cms.hhs.gov.

To apply by mail, print the request form from https://nppes.cms.hhs.gov and send the completed application to:
NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059

Because of the volume of requests expected, providers are encouraged to apply early and allow time to receive the number from the enumerator.

How many numbers do I need to request?
To ensure that reimbursement is not affected by this change, providers are strongly encouraged to apply for NPI number(s) based on how their organization or practice is currently enrolled in the Alabama Medicaid program. In most cases, providers should obtain a NPI for each provider number they currently have. Large or complex organizations may want to contact their EDS Provider Representative for assistance before requesting numbers.

Note: All providers requesting a NPI number must also request at least one taxonomy code. Provider taxonomy codes are an administrative code set identifying a provider type and area of specialization for all health care providers. A given provider may have up to five taxonomy codes, depending on their specialty areas. Any taxonomy codes received should be provided to EDS along with the NPI number.

What do I do once I receive my NPI number(s)?
Once the NPI number and any taxonomy codes are received, they should be submitted to EDS using the NPI Notification Form available from EDS. EDS is now ready to receive this information.

Providers will need to send 1) The completed NPI Notification Form, and 2) a copy of the NPI notification letter received from the enumerator to EDS. The documents can be mailed to the address on the form or faxed to the number indicated on the form. A copy of the Notification Form is also available on the Alabama Medicaid website at www.medicaid.alabama.gov under Billing/Forms/Provider Enrollment Forms.

Note: Providers will continue to submit claims with their current Alabama Medicaid-issued provider numbers until the new system to accommodate NPI numbers is implemented on February 25, 2008.

What if I have other questions about NPI?
If you have questions regarding how to fill out the NPI Notification Form, contact your Provider Representative at 1-800-688-7989 (within Alabama) or (334) 215-0111 (outside Alabama).
 

 

 

 

 

 
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