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NPI FAQs

 1.  What is a National Provider Identifier (NPI)?
 
 2.  How can I submit my NPI to Molina Healthcare?
 
 3.  What is a Pay-To provider?
 
 4.  I don’t have internet access, how do I submit my NPI?
 
 5.  Can I make corrections to the demographic information displayed on the NPI collection screens or excel spreadsheet?
 
 6.  Can I enter the same NPI for multiple subparts?
 
 7.  If I have already submitted my NPI to Molina Healthcare do I need to resubmit it via the Provider Self Services Portal?
 
 8.  When will Molina Healthcare end its NPI Contingency Plan?
 
 9.  When will Molina Healthcare accept the revised CMS (HCFA) 1500 claim form?
 
 10.  When will Molina Healthcare accept the revised UB claim form?
 
 11.  When will Molina Healthcare accept the NPI in the 837 EDI format?
 
 12.  When will I be required to use the NPIs on my claims?
 
 13.  I submit paper claims only. Will I need an NPI?
 
 14.  Are all providers required to submit NPIs?
 
 15.  Will Molina Healthcare accept Medicaid ID numbers after May 23, 2008?
 
 16.  How many NPI numbers will be required on a claim?
 
 17.  Must I submit an NPI for each provider at the clinic?
 
 18.  Is Molina Healthcare collecting NPIs for non-contracted providers?
 
 19.  Does Molina Healthcare need my taxonomy code?
 
  Q1. What is a National Provider Identifier (NPI)? Top
 
    Bullet The NPI is a ten-digit number, which must be used on HIPAA standard electronic transactions, such as claims, to identify a provider. The Centers for Medicare and Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to identify providers and assign NPIs. To apply for an NPI go to https://nppes.cms.hhs.gov/NPPES/Welcome.do.

For additional information on the NPI, click to visit the Molina Healthcare Website
 
 
  Q2. How can I submit my NPI to Molina Healthcare? Top
 
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The most efficient method for submitting your NPI to Molina Healthcare is through our Provider Self Services Portal. The Provider Self Services Portal allows you to view the Pay-To, Rendering and Subpart providers that Molina Healthcare has on file and provides a tool to enter the corresponding NPI (a Pay-To provider is the provider who is set up in Molina Healthcare’s claims processing system to receive checks). There are 2 available options for submitting your NPI through the Provider Self Services Portal:

 
   
  Bullet Online NPI Submission
   

Enter your NPI directly onto a webpage which is pre-populated with the demographic information we currently have on file.

 
  Bullet Upload Excel Spreadsheet
   

This option allows you to download a spreadsheet, which is pre-populated with the demographic information we currently have on file, enter your NPIs and upload the spreadsheet to Molina.

 
  Q3. What is a Pay-To provider? Top
 
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A Pay-To provider is the provider who is set up in Molina Healthcare’s claims processing system to receive checks.

 
  Q4. I don’t have internet access, how do I submit my NPI? Top
 
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Please contact your Provider Service Representative and be prepared to provide your NPI, tax ID # and QMACS/QNXT provider ID# (if known). Your Provider Service Representative can also provide a fax number for you to send your information to.

 
  Q5.

Can I make corrections to the demographic information displayed on the NPI collection screens or excel spreadsheet?

Top
 
    Bullet

No, please do not modify any pre-populated information on the collection screens or spreadsheet - it is displayed for reference only. Only NPIs will be accepted - modifications to other information will not be accepted.

 
  Q6. Can I enter the same NPI for multiple subparts? Top
 
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Yes, if that is how you have enumerated.

 
  Q7.

If I have already submitted my NPI to Molina Healthcare do I need to resubmit it via the Provider Self Services Portal?

Top
 
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It would be helpful, but it is not necessary. Entering your NPI in the Provider Self Services Portal will link it electronically to your Molina system ID number.

 
  Q8. When will Molina Healthcare end its NPI Contingency Plan? Top
 
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Molina Healthcare will end its Contingency Plan on 5/23/2008. Molina will reject claims that do not contain the NPI as the primary provider identifier as required by the NPI Rule. Legacy IDs (ex: State License number, Medicaid and Medicare IDs) will no longer be accepted.

 
  Q9. When will Molina Healthcare accept the revised CMS (HCFA) 1500 claim form? Top
 
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Molina is currently accepting the revised CMS (HCFA) 1500 claim form. Effective 5/23/08 Molina will only accept revised CMS (HCFA) 1500 Claim forms.

 
  Q10. When will Molina Healthcare accept the revised UB claim form? Top
 
    Bullet Molina is currently accepting the revised UB claim form. Effective 5/23/08 Molina will only accept the revised UB 04 claim form.
 
  Q11. When will Molina Healthcare accept the NPI in the 837 EDI format? Top
 
    Bullet January 1, 2007
 
  Q12. When will I be required to use the NPI on my claims? Top
 
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Beginning May 23, 2008, all provider claims, both paper and electronic submissions, must include the NPI in order for payments to be issued. Legacy IDs will no longer be accepted.

 
  Q13. I submit paper claims only. Will I need an NPI? Top
 
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Yes, Molina Healthcare submits all claims electronically to state Medicaid agencies for statistical purposes. The state Medicaid agencies are requiring the NPI on all encounters.

 
  Q14. Are all providers required to submit NPIs? Top
 
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Yes, for electronic claims it is mandated for HIPAA compliance. For paper claims Molina Healthcare has made a business decision to require NPIs. Only atypical providers are exempt, i.e. Meals on Wheels, etc…

 
  Q15. Will Molina Healthcare accept Medicaid ID numbers after May 23, 2008? Top
 
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No, after May 23, 2008 for all standard transactions, a covered health care provider may use only its NPI to identify itself as a health care provider.

 
  Q16. How many NPI numbers will be required on a claim? Top
 
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Primary providers such as the Rendering and Pay-To providers must be identified by their NPI. Molina Healthcare requests that all other providers, such as referring providers, be identified by their NPI if known.

 
  Q17. Must I submit an NPI for each provider at the clinic? Top
 
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Health plans configure providers differently. For example, some Molina Healthcare state plans do not enter individual Physical Therapists in the system; however the clinic NPI is entered in the system. If you have questions, please contact your Provider Service Representative.

 
  Q18. Is Molina Healthcare collecting NPIs for non-contracted providers? Top
 
    Bullet Yes.
 
  Q19. Does Molina Healthcare need my taxonomy code? Top
 
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Molina Healthcare is not collecting taxonomy codes during the NPI collection process. However, Molina Healthcare is requiring taxonomy codes on Institutional electronic and paper claims.