National Provider Identifier (NPI)
The NPI is a 10-digit standard unique identifier for health care providers. It replaces any health care provider identifiers in use today, including the nine-digit Medi-Cal provider number. Health Insurance Portability and Accountability Act (HIPAA) of 1996 required a standard unique identifier for all health care providers for use in the nationwide health care system- the NPI. The National Plan and Provider Enumeration System (NPPES) was developed by the Centers for Medicare & Medicaid Services (CMS) in compliance with the HIPAA requirement. NPPES is the CMS-sponsored data repository for NPI-related information. It processes new applications, updates and generates NPIs. The NPPES website address is https://nppes.cms.hhs.gov. The NPI Enumerator is a CMS-contracted vendor that will perform provider registration and enumeration processing using the NPPES. The Enumerator enters data from paper applications, resolves problems and answers questions related to NPI and the registration process. Once the data processing is completed, the Enumerator will notify providers of their assigned NPI.
NPI Enumerator’s contact information:
Mailing: NPI Enumerator / PO Box 6059 / Fargo, ND 58108-6059
Medi-Cal Provider Enrollment
In January 2013 Medi-Cal began requiring FQHC providers be individually enrolled in Medi-Cal if they order, refer or prescribe. Health centers enroll in the Medi-Cal program using the health center's NPI through L&C. The health center's reimbursement is not changing. This new process is for 3rd party providers to get reimbursed (like the pharmacies, specialists, etc.). FQHC providers will need to be individually enrolled if they order, refer or prescribe. If health centers do not individually enroll their providers, when they refer their patients to someone like a specialist, the specialist will not get paid which could cause the specialist to stop accepting referrals from the health center. The same with pharmacy...if the health center does not individually enroll their providers (it won't stop payment to the health center) but the patient may not get their prescriptions filled.
CPCA Staff Contact
For questions regarding provider enrollment, please contact Emily Shipman, Senior Program Coordinator of Health Center Operations, at firstname.lastname@example.org.