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Effective April 1, 2012, Georgia Medicaid (CPID 1494) will enforce the 5010 National Provider ID (NPI) billing requirement change.

Currently, claims submitted to Georgia Medicaid with an individual NPI in the Billing Provider loop (Loop 2010AA, NM109) are accepted; however, as they complete their 5010 transition on March 31, 2012, claims may no longer be billed this way and will be rejected by the payer for reporting invalid billing provider information on the claim.

According to the 5010 NPI Requirement change, the only time the Billing Provider NPI may be an individual is when the healthcare provider performing the services is an independent entity. If the provider has a group, or payee NPI, that number is required to be reported as the Billing Provider loop (Loop 2010AA, NM109)

The change is being enforced April 1, 2012. Providers must adjust Billing Provider NPI by March 31, 2012 to avoid claim rejections.

Action Required: Providers need to work with Georgia Medicaid to determine the correct NPI to be reported as the Billing Provider NPI. Once it is determined which NPI is appropriate, ensure you are placing the correct value in the Billing Provider loop (Loop 2010AA, NM109). Making these changes now will minimize the risk of claim rejections when the payers 5010 transition is completed.

If you have any questions, please contact Client Services at 1-888-348-8457, option 2.

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