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National Provider Identifier Getting an NPI is free; not having one can be costly. NOTICE- DMAP is now fully NPI compliant. We will no longer process electronic claims without a valid NPI that has been registered with DHS. If you have not yet completed Business-to-Business testing with your NPI and taxonomy codes, please contact EDI Support at 888-690-9888 or DHS.EDIsupport@state.or.us.
Questions? Contact DHS EDI Support Services: DHS.EDIsupport@state.or.us or 1-888-690-9888. ___________________________________________________________________________________
Announcements are posted in order of their issue dates for historical purposes. The most recently dated information supersedes all previous versions.
What is the NPI registration deadline for DHS? DHS established a final deadline of December 31, 2007. After that date, DHS will process only EDI transactions that include appropriate NPIs and taxonomy codes. If you are a small health plan, you might be subject to a later deadline, May 23, 2008. Refer to the rules within the Federal Register to determine your individual status.
Why do I need this new number? The Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for all health care providers to improve the efficiency and effectiveness of the electronic transmission of health information. More information is available at the federal site; just click here. The 10-digit NPIs were created to replace all unique numbers for covered entities that have been assigned by various payers, such as DHS’ six-digit provider number.
The Centers for Medicare and Medicaid Services (CMS) established the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. You may apply online by following the directions on their Web site above. Once you receive an NPI, notify the EDI Support Team using this fax form. Include your DHS provider number, NPI and the taxonomy code(s) you selected.
What are taxonomy code(s)?
What taxonomy code(s) should I use?
Will DHS require taxonomy codes on claim submissions? If providers have identified themselves to us with a taxonomy code(s), use that taxonomy code(s) whenever submitting an electronic claim to DHS so we can make a positive one-to-one match.
Whenever there is a discrepancy between the identifiers in our records and your claim submission identifiers, DHS will try to make a match using the provider name, address, etc. so it’s important to use the same name on every claims transaction.
If DHS staff cannot make a positive match, we need to work with you to ensure a resolution for future claims. Contact EDI Support Services at 888-690-9888 or DHS.EDIsupport@state.or.us.
Will taxonomy codes be required for the referring provider if another entity is billing? An individual provider should only have one NPI, so the NPI in this case should be sufficient for DHS to gain a one-to-one match; however, it is always safer to include a taxonomy code where one has been identified in the NPI enumeration process. If the claim is denied for a referring provider reason, the provider should work with DMAP’s Provider Services Unit to determine the cause of the denial, as it may be unrelated to the NPI. Contact DMAP Provider Services at 800-336-6016 or DMAP.providerservices@state.or.us.
What if I’ve forgotten which codes I chose? Call the NPPES at 1-800-465-3203.
When will DHS use the NPI for paying claims? DHS has been using NPIs for paying claims since May 23, 2007.
Can I use my NPI on DHS claims now? DHS will accept the NPI on all claim formats; however, if you have not registered your NPI with us, you must also use your DHS six-digit number because our computerized systems will only recognize DHS numbers at this time.
DHS made a business decision to require NPIs and DMAP six-digit provider numbers for covered entities on paper claims effective May 23, 2007.
DHS status on NPI implementation (PDF) - Information updated 12/12/2007
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