Medicaid is updating its claims payment system to require the inclusion of individual rendering provider NPIs on clinic claims. This work is necessary to implement a federal requirement. The projected implementation date of this systems work is July 1, 2018 for Ohio Medicaid and its Medicaid managed care plans.
This systems work will change how clinics currently report NPIs in the Rendering Provider fields of Medicaid claims. Currently, clinics list their billing NPI in the rendering field. Effective July 1, 2018, clinics will report individual NPIs in the Rendering Provider fields with the applicable procedures on claims. This change will also mean that individual providers working at clinics will need to enroll with Medicaid, and then affiliate themselves with the clinic. Information on how to affiliate individual providers to your clinics can be obtained through Medicaid’s Provider Enrollment area at: 1-800-686-1516.
You may also need to reach out to your vendor to update your system for this change.
Note – FQHCs and RHCs are also be impacted by this change.
|
Impacted Ambulatory Health Care Clinics (PT 50) |
Medicaid Provider Type |
Medicaid Provider Type Specialty |
Allowable Overseeing Providers That May List Their Individual NPIs in the Rendering Fields of Clinic (PT 50) Claims Starting July 1, 2018 |
|
Primary Care Clinic |
50 |
500 |
Physician (PT 20), Physician Assistant (PA) (PT 24), APRN (PTs 65, 71, 72, 73), Chiropractor (PT 27) |
|
Public Health Department Clinic |
50 |
501 |
Physician (PT 20), PA (PT 24), APRN (PTs 65, 71, 72, 73) |
|
Outpatient Rehabilitation Clinic |
50 |
502 |
Physician (PT 20), PA (PT 24), APRN (PTs 65, 71, 72, 73), PT (PT 39), OT (PT 41) |
|
Family Planning Clinic |
50 |
503 |
Physician (PT 20), PA (PT 24), APRN (PTs 65, 71, 72, 73) |
|
Speech-Language-Audiology Clinic |
50 |
504 |
Physician (PT 20), PA (PT 24), APRN (PTs 65, 71, 72, 73) |
|
Professional Optometry School Clinic |
50 |
505 |
Physician (PT 20), Doctor of Optometry (PT 35) |
|
Professional Dental School Clinic |
50 |
506 |
Dentist (PT 30) |
Please contact Melissa Little, Ohio Department of Medicaid, if you have questions about this change.