As mandated by the Health Insurance Portability and Accountability Act (HIPAA) and in compliance with the Centers for Medicare and Medicaid Services (CMS), covered providers must have a National Provider Identification (NPI) number and share it with other providers, health plans, clearinghouses and other entities for billing purposes.
As of May 23, 2008, the NPI number is required for all billing transactions.
All electronic and paper claims submitted after May 23, 2008 without NPI information identified in the appropriate fields are denied or returned for correct submission.
Also, only CMS 1500 professional claim forms and UB-04 institutional claim forms are accepted after May 23, 2008. These forms are not supplied by South Dakota Medical Assistance (SDMA).
Health care providers who bill SDMA for services need an NPI number, except for non-emergency community transportation services who only transport ambulatory individuals. This provider type will continue to bill SDMA with the seven digit Medicaid provider number.
When submitting NPI information, please consider how you are billing SDMA. If an entity has been assigned various group NPI numbers for its subparts, then SDMA will need to know those group NPI numbers and associate those numbers with the matching SDMA seven digit Medicaid provider number.
If an entity has been assigned a group NPI number for the clinic and/or taxing entity (Federal Tax Identification Number), SDMA must know this NPI group number and associate it with the individual NPI numbers assigned to the rendering/servicing provider of this clinic.