| General |
 | CMS Frequently Asked Questions (FAQ) about NPI |
| This will link you directly to the most updated Centers for Medicare and Medicaid Sevices (CMS) FAQ page for questions and answers specific to NPI. |
 | CMS Announcements: NPI Timelines and Other Information |
| Information posted October 29, 2007: This article contains the most updated Centers for Medicare and Medicaid Sevices (CMS) outreach announcements specific to NPI. |
| NPI Application Information |
| Banner Message posted 6/5/06 |
| Taxonomy Codes Required on Electronic Claims |
| Information posted June 11, 2007: The Health Care Provider Taxonomy Code Set is an external, nonmedical collection of alphanumeric codes designed to classify health care providers by provider type and specialty. It is critical that the taxonomy code selected as the primary or secondary taxonomy code during attestation is included in all electronic submissions to TMHP. For example, the taxonomy code attested with TMHP must be the same taxonomy code recorded on the claim. NPI-only claims that are submitted without a taxonomy code will be rejected. Taxonomy codes do not affect pricing or the level of pricing; they are used to crosswalk the NPI to a Texas Provider Identifier (TPI). Refer to the 2007 National Provider Identifier (NPI) Special Bulletin, No. 202 article titled ”Crosswalk Solution Developed for Claims Processing," located on page 9. For more information about the requirements for taxonomy codes on electronic claims, call the TMHP Contact Center at 1-800-925-9126. |
| Updated Taxonomy Codes for NPI Attestation |
| Information posted July 16, 2007: TMHP has recently updated the taxonomy codes that are associated with various provider types and specialties and are displayed during the National Provider Identifier (NPI) Online Attestation Process on the TMHP website. Click on the title to view the details. |
| Updated Article for National Provider Identifier (NPI) Special Bulletin, No. 205 |
| Information posted July 23, 2007: TMHP has identified a correction to an article published in the June 2007 National Provider Identifier (NPI) Special Bulletin, No. 205, entitled “NPI Contingency Period Announced,” under the subheading “NPI-Only or Prior Submission Options Phase.” The subheading contained sections entitled “Remittance and Status (R&S) Reports” and “ER&S Reports” that incorrectly indicated August 3, 2007, as the date on which R&S and Electronic Remittance and Status (ER&S) reports will include NPIs and related data. The correct date on which the revised R&S and ER&S reports will be available is August 10, 2007. Click on the title to view the details. |
| Correction to the NPI Special Bulletin for Long Term Care (LTC) Providers |
| Information posted July 23, 2007: This is a correction to the Quick Reference Guide in the June 2007 National Provider Identifier (NPI) Special Bulletin for Long Term Care (LTC) Providers, No. 205, on page 9. In the box labeled “TDHconnect/TexMedConnect Transactions,” the third bullet contains an incorrect date of July 27, 2007. The complete, corrected third bullet is, "TMHP online TexMedConnect will accept and return NPI/API only for MESAV transactions beginning 8/27/07.” For more information, call the TMHP Call Center/Help Desk at 1-800-626-4117.
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| Full Compliance with National Provider Identifier (NPI) To Be Required Effective March 1, 2008 |
| Information posted November 5, 2007: Effective March 1, 2008, full compliance with National Provider Identifier (NPI) will be required. Click on the title to view the details. |
| Electronic Transaction Changes Effective March 1, 2008 |
| Information posted December 24, 2007: Effective March 1, 2008, electronic claims must be submitted with a National Provider Identifier (NPI) for the billing, performing, attending, ordering, facility, and referring providers. If an NPI is not included or if a legacy provider identifier is submitted, the claim will be rejected. Other electronic transactions, such as eligibility verification and claim status inquiries, must also be submitted with an NPI. If an NPI is not included or if a legacy provider identifier is submitted, these transactions will be rejected. Click on the title to view the details. |
| NPI Verification To Start in March 2008 |
| Information posted January 9, 2008: Effective March 1, 2008, TMHP will verify the National Provider Identifiers (NPIs) provided during attestation against the National Plan and Provider Enumeration System (NPPES) to ensure all attested NPIs are active. TMHP will send a notification letter to all providers whose NPIs are listed with NPPES as inactive. Providers will be allowed a 60-day grace period to contact NPPES to resolve their NPI status. If the inactive NPI has not been reinstated within the 60-day grace period, TMHP will disenroll all Texas Provider Identifiers (TPIs) associated with the inactive NPI. TMHP will also close all PCCM panel reports for the disenrolled TPIs. Clients enrolled in these panel reports will be notified to choose a different primary care provider.
For more information, call the Provider Enrollment Department at the TMHP Contact Center at 1-800-925-9126, option 2, or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413, option 2.
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| NPI Contingency Period Extended Through May 23, 2008 |
| Information posted February 8, 2008: The state of Texas contingency period for National Provider Identifier (NPI) compliance has changed and will not end on February 29, 2008. The Health and Human Services Commission (HHSC) and the Texas Medicaid & Healthcare Partnership (TMHP) have extended the NPI contingency period through May 23, 2008. Click on the title to view the details. |
| CSHCN Attestation |
| Information posted February 18, 2008: TMHP has completed the National Provider Identifier (NPI) attestation for CSHCN Services Program providers who have completed the NPI attestation of their Texas Medicaid Program Texas Provider Identifier (TPI.) The NPI attestation was completed using the CSHCN Services Program TPI and the NPI, taxonomy code, and physical address provided during the NPI attestation with the Texas Medicaid Program. |
| Electronic Claims Update for Group Billing Providers |
| Information posted March 14, 2008: Effective April 25, 2008, group billing providers that submit National Provider Identifier (NPI)-only claims for professional and dental services are no longer required to submit the taxonomy code they provided during attestation. Electronic claims that do not contain the group billing provider taxonomy code will no longer be rejected. Group billing providers can continue to send the taxonomy code to assist with the NPI crosswalk. Click on the title to view the details. |
 | Texas Medicaid National Provider Identifier (NPI) Special Bulletin No. 217 |
| Information Posted April 23, 2008: The May 2008 Special Bulletin No. 217 is now available. Click the title to view the bulletin.
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| Correction to the Paper Appeals Requirements that are Effective May 23, 2008 |
| Information posted May 9, 2008: This is a correction to an article published in the May 2008 National Provider Identifier (NPI) Special Bulletin, No. 217, entitled “Claims Submission Reminders.” Under the “Appeals” subheading, the article incorrectly indicated that providers have the option to submit appeal requests on paper for Texas Provider Identifier (TPI)-only claims that were submitted before the end of the contingency period. |
| New Benefit Code Helps Mental Health Providers with NPI Crosswalk |
| Informaton posted May 9, 2008: Benefit code MH2 has been created to assist with the National Provider Identifier (NPI) crosswalk solution. The new benefit code must be used by case management mental health mental retardation (MHMR) providers that submit NPI-only claims to Texas Medicaid. A benefit code is an additional data element that the Texas Medicaid & Healthcare Partnership (TMHP) uses to identify state programs.
For more information, call the TMHP Contact Center at 1-800-925-9126.
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| Correction to Paper Claims Instructions Bulletin Article |
| Information posted May 16, 2008: This is a correction to a bulletin article that was published in the May/June 2008 Texas Medicaid Bulletin No. 215 entitled “National Provider Identifier Implemented May 23, 2008”. Under the “Paper Claims” subheading, the instructions for fields 76, 78 and 79 of the UB-04 CMS-1450 Claim Form contained incorrect information. Paper claims require a Texas Provider Identifier (TPI) in addition to the National Provider Identifier (NPI) only for the billing and performing providers. All other provider fields on the claim forms (referring, facility, admitting, other A or B, and operating) require only the NPI. Click on the title for the complete article. |
| Paper Crossover Claims Reminder |
| Information posted May 23, 2008: Reminder: Providers must submit paper Medicare-primary claims using the TMHP Standardized MRAN form, or by submitting the computer-generated MRAN from the CMS-approved software application Medicare Remit Easy Print (MREP) for professional services or PC-Print for institutional services.
Providers must submit the appropriate Texas Provider Identifier (TPI) with the claim. For example, providers billing for professional services on paper must send claims to TMHP on a CMS-1500 claim form with their individual provider identifier. Submission with the incorrect TPI on the wrong MRAN form (professional versus institutional services) will result in a claim denial.
Effective May 23, 2008, crossover paper claims must include the National Provider Identifier (NPI) in addition to the TPI for the billing provider.
For more information, call the TMHP Contact Center at 1-800-925-9126.
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| NPI Claims Reminder |
| Information posted June 6, 2008: Reminder: All electronic and paper claims must contain the provider identifier(s), name, street, city, state, ZIP+4 Code, and telephone number of the billing provider in the appropriate billing provider fields. The address in this field must contain the billing provider’s address that was provided during attestation. The facility provider information fields must be completed if services were provided in a place other than the patient's home or the billing provider's facility. The facility provider information fields must contain the name, address, ZIP+4 Code, and the National Provider Identifier (NPI) of the facility where the service was provided. |
| Correction to “NPI Claims Reminder” |
| Information posted June 14, 2008: This is a correction to an article that was posted on the TMHP website at www.tmhp.com on June 6, 2008, entitled “NPI Claims Reminder”. The article incorrectly stated that providers must enter a physical address in Block 24J of the CMS-1500 claim form. Field 24J must contain only the rendering provider’s NPI. In addition, the article incorrectly indicated “32 a-b” instead of Block 33 of the CMS-1500 claim form and did not indicate when to submit a Texas Provider Identifier (TPI) on the CMS-1500 and ADA Dental Claim Form. Click on the title to view the complete, corrected article. |
| NPI Claim Denials |
| Information posted June 20, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has seen an increase in National Provider Identifier (NPI)-related claim denials since the NPI full implementation began on May 24, 2008. The reasons for these claim denials include missing NPI information, NPI information entered in an incorrect format, and missing taxonomy codes. Click on the title to view the details. |
| National Provider Identifier (NPI) Verification |
| Information posted June 27, 2008: Effective April 25, 2008, TMHP began verifying the National Provider Identifiers (NPIs) that were provided during attestation against the National Plan and Provider Enumeration System (NPPES) to ensure that all attested NPIs are active.
Providers may have received letters from Centers for Medicare & Medicaid Services (CMS) NPI Enumerator regarding issues that need to be corrected. Providers must correct all of the NPI issues that were identified by the CMS NPI Enumerator. Providers must contact the CMS NPI Enumerator at the phone number listed on the letter to discuss the issues that were identified. Providers must correct all NPI issues identified by CMS NPI Enumerator. Failure to correct these issues will result in an automatic deactivation of the NPI and the subsequent disenrollment of the TMHP Texas Provider Identifier (TPI) associated with the deactivated NPI.
TMHP will send a notification letter to all providers that have NPIs listed as inacti |
| Group Provider Claims for THSteps |
| Information posted July 28, 2008: Group providers are not required to submit a rendering or performing provider identifier on claims for Texas Health Steps (THSteps) medical services. Groups can enroll and bill for THSteps medical services; however, their enrollment is not set up as a group.
Electronic claims for THSteps medical services must be submitted with the THSteps billing provider’s National Provider Identifier (NPI), benefit code, and the TMHP attested taxonomy code. Failure to supply the taxonomy code for the billing provider may result in the rejection of claims.
Paper claim submissions must be submitted with the billing provider’s NPI, Texas Provider Identifier (TPI), and benefit code.
THSteps medical claims must be submitted with the appropriate modifier. Refer to the 2008 Texas Medicaid Provider Procedures Manual, Section 43, “Texas Health Steps (THSteps).”
For more information, call the TMHP Contact Center at 1-800-925-9126.
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| THSteps Claims |
| Information posted August 29, 2008: Reminder: Texas Health Steps medical providers must never submit a rendering or performing provider identifier on claims for THSteps services. Using a performing provider identifier on claims will cause claim denials.
For more information, call the TMHP Contact Center at 1-800-925-9126.
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| Update to Telephone Appeals Provider Identifier Requirements |
| Information posted September 26, 2008: This is an update to a banner message that first appeared on the June 2, 2008, Remittance and Status (R&S) Report and a website article posted on this website on May 30, 2008, titled, “NPI Required for Telephone Appeals.” The article did not indicate that a Texas Provider Identifier (TPI) may still be required in addition to the National Provider Identifier (NPI) for certain appeals requests. Click on the title for the complete, revised article. |
| Taxonomy Codes Expanded |
| Information posted October 3, 2008: Beginning October 1, 2008, the taxonomy codes associated with various provider types and specialties that are displayed during the National Provider Identifier (NPI) online attestation process on the TMHP website at www.tmhp.com, have been expanded. Providers are encouraged to review the taxonomy codes that are now available and, if necessary, update their attestation data. Click on the title to view the details.
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| Providers Reminded to Keep Their NPIs Active |
| Information posted October 3, 2008: Reminder: Providers must keep their National Provider Identifiers (NPIs) active and their National Plan and Provider Enumeration System (NPPES) records updated. Click on the title for more information. |
| Attestation |
| Submitting Taxonomy Codes for NPI Attestation |
| Information posted March 12, 2007: In preparation for the May 23, 2007, federal deadline for the use of the National Provider Identifier (NPI), TMHP has created a page on the TMHP website that enables providers to report their NPI. Providers must attest to NPI data for each of their current Texas Provider Identifiers (TPIs). TMHP strongly suggests that providers complete attestation as soon as possible. Providers who have begun the NPI attestation process on the TMHP website may have found that some of the taxonomy codes listed on the confirmation page from the National Plan and Provider Enumeration System (NPPES) do not match the taxonomy codes automatically populated on the TMHP website Attestation Data Screen. Click on the title to view the details. |
| Attest an NPI |
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| NPI Implementation Update |
| NPI Special Bulletin No. 205 |
| June 2007 Texas Medicaid Special Bulletin No. 205 |
| Long Term Care NPI Special Bulletin No. 205 |
| June 2007 Long Term Care NPI Special Bulletin No. 205 |
| Provider Education Information |
| NPI Workshop Registration |
| Banner message posted 10/2/06 |
| LTC NPI Workbook |
| Long Term Care NPI Workbook |
| NPI Acute Care Workbook |
| Acute Care NPI Workbook |
| Revised Claim Forms Information |
| Family Planning 2017 Claim Form Revision |
| Information posted April 11, 2007: The Family Planning 2017 Claim Form for paper billers has been revised for the implementation of the National Provider Identifier (NPI). Effective May 21, 2007, all Title V, Title X, and Title XX family planning providers and any participating Texas Medicaid Program providers who currently use the Family Planning 2017 claim form must use the revised version of the Family Planning 2017 Claim Form for claim submissions and appeals, regardless of the version used for prior submissions. Claims submitted on the revised version of the Family Planning 2017 Claim Form before May 21, 2007, will be returned to the provider.
Details of these changes are available on the TMHP website at www.tmhp.com and will be available in the May/June 2007 Texas Medicaid Bulletin.
For more information, call the TMHP Contact Center at 1-800-925-9126. |
| UB-04 CMS 1450 Claim Form to Replace UB-92 CMS-1450 claim form |
| Information posted April 11, 2007: The National Uniform Billing Committee (NUBC) has approved the replacement of the current uniform billing UB-92 CMS-1450 claim form with the new UB-04 CMS-1450 claim form. TMHP will accept the new UB-04 CMS-1450 claim form beginning May 21, 2007.
Click on the title for more information. |
| Revised CMS1500 Claim Form Update |
| Information posted April 11, 2007: This is an update to previous notifications regarding the revised version of the CMS-1500 claim form (08/05). The revised version of the CMS-1500 claim form (08/05) will be implemented on April 2, 2007; however, providers can continue to submit claims to TMHP on the previous version of the CMS-1500 claim form (12/90). Until further notice, claims that are submitted on the previous version of the CMS-1500 claim form (12/90) will be accepted and will not be returned to the provider.
The previous version of the CMS-1500 claim form (12/90) does not contain a field for the National Provider Identifier (NPI); therefore, providers using the previous CMS-1500 claim form version (12/90) should submit only the Texas Provider Identifier (TPI).
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413. |