Nebraska Medicaid Program
National Provider Identifier (NPI)
Frequently Asked Questions (Updated 3/31/06)
- When will Nebraska Medicaid require Trading Partners and Providers to submit the NPI on the 837 transaction?
We will require the NPI on the 837 transaction with the implementation of the new MMIS. However, until the new MMIS is installed, Nebraska Medicaid will be able to accept the NPI, and continue to require the legacy Medicaid provider number and other legacy identifiers (SSN and state license number) on 837 transactions to process claims and make payment.
- When will Nebraska Medicaid begin accepting the NPI?
In September 2006, Nebraska Medicaid completed system changes to be able to accept NPIs on 837 transactions. Trading Partners must complete NPI testing prior to submitting NPIs. Contact the EDI Help Desk at email@example.com or 1-866-498-4357 to schedule NPI testing. The Nebraska Medicaid NPI Test Plan can reviewed at www.dhhs.ne.gov/med/NPI.htm.
- Does Nebraska Medicaid require testing claims prior to a trading partner or provider submitting an NPI? If yes, what are the testing requirements?
Yes, each Trading Partner must arrange testing through the Medicaid EDI Help Desk prior to submitting claims with NPI. Two successful files of no more than 20 – 25 claims each are required to assure that claims are accepted and processed correctly with NPI. We recommend that Trading Partners review Nebraska Medicaid NPI Test Plan prior to testing. Medicaid’s NPI Trading Partner Testing Plan is available at www.dhhs.ne.gov/med/NPI.pdf
- Does Nebraska Medicaid accept the NPI on paper claim forms?
Nebraska Medicaid will accept the NPI on the new CMS 1500 and 1450 paper claim forms but will require the legacy provider numbers (Medicaid Provider Number, Social Security Number and State License Number) to process claims and make payment.
- What other provider ID's will Nebraska Medicaid require on 837 electronic transactions until claims are processed using only the NPI?
Nebraska Medicaid will need the Provider’s legacy Nebraska Medicaid Provider ID, State License Number, or Social Security Number (SSN) on claims as secondary identifiers for payment of claims until implementation of the new MMIS. Please refer to the current Nebraska Companion Guides to determine the appropriate Legacy ID to use. The companion guides can be found at www.dhhs.ne.gov/med/edindex.htm
- Will Nebraska Medicaid require the referring physician NPI?
The referring physician NPI will be accepted and stored but will not be required or processed within the current system. The referring physician State License Number will be necessary to process claims as stated in the Nebraska Companion Guide.
- Will Nebraska Medicaid validate NPIs received on electronic transactions?
Nebraska Medicaid will not validate the check-digit of NPIs. NPIs that are 10 digits and all numeric will be accepted for information-only purposes by Nebraska Medicaid. Claims will be processed using Nebraska Medicaid legacy identifiers.
- Will Nebraska Medicaid reject claims based on NPI?
Claims will not reject based on NPI, but will reject if the legacy identifier (Medicaid Provider Number for the Billing Provider) is not present or is invalid. Claims that do not reject process through Nebraska’s current Medicaid Management Information System (MMIS) edits.
- Will providers need to register their NPI with Nebraska Medicaid?
Not during the interim period when we are accepting NPI and processing claims with our current MMIS system. Nebraska Medicaid anticipates re-enrolling providers with their NPIs with the new MMIS. We will notify providers how this will be done prior to implementation of the new MMIS.
- Will the reports we get back from Nebraska Medicaid contain the NPI?
The same 10-digit numeric Billing Provider NPI submitted on 837 transactions will be returned on the 835 in the 2100 loop NM 109 segment.
- Will other reports providers receive from Nebraska Medicaid continue to contain the current Medicaid Provider number?
Yes. Nebraska will not be making any changes to other reports at this time.
- What date will you be only accepting NPI?
Please refer to the Implementation Strategy Statement.
If you require clarification of this information or have additional questions, contact:
Medicaid EDI Help Desk
866-498-4357 (toll free)
471-9461 (in Lincoln)