RCPA - Rehabilitation and Community Providers Association


DPW Issues NPI Bulletin and Legacy Dual Strategy
June 2, 2007

The Department of Public Welfare (DPW) issued Medical Assistance Bulletin 99-07-07, Instructions for Using Your National Provider Identifier (NPI) Number to Bill the Department of Public Welfare (DPW) and Contingency Plan, on May 18. Effective May 23, 2008, DPW will require the NPI in the billing and rendering provider fields on Health Insurance Portability and Accountability Act (HIPAA) covered transactions. DPW will use the NPI number, the taxonomy, and the nine-digit zip code to crosswalk to a legacy provider identification number and service location. Providers must use the NPI number, taxonomy, and nine-digit zip code that they registered with DPW for the service location.

Beginning today a dual strategy using the legacy number, the NPI, or both in the billing and rendering provider fields is implemented. If a legacy number is used, then the legacy number will be used to process the claim. At some time before May 23, 2008, DPW will begin to process claims using the NPI. DPW will provide notification of changes in processing as they approach. For pharmacy claims using National Council for Prescription Drug Programs (NCPDP) transactions, either the legacy number or the NPI can be used in the Service Provider ID field. Either the prescribing provider’s license number or NPI can be used in the Prescriber ID field. Beginning May 23, 2008, the NPI number will be required for processing pharmacy claims.

Atypical providers do not provide healthcare and should not obtain an NPI. However, a provider that bills for both healthcare and atypical services using the same 13-digit PROMISe identification number is considered a healthcare provider for that service location and must obtain an NPI number and register it with DPW.

In addition to the bulletin, DPW has issued an NPI Fact Sheet, Legacy Dual Strategy – Effective June 1, 2007, that is a quick reference for this information. Weekly registration statistics continue to indicate low registration rates for behavioral health service providers. PCPA members are encouraged to obtain NPIs and register them with DPW as soon as possible. More complete information, including the bulletin, registration information, and information on atypical providers, is available on the DPW web site (www.dpw.state.pa.us/Business/NPIinfo).

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