Providers that are currently set up to send electronic claims to Nebraska Medicaid, CPIDs 1476 and 1520, please be aware of a National Provider ID (NPI) billing requirement change to the payer’s 5010 format this year.
• A new Nebraska Medicaid Trading Partner Authorization must be completed for 5010 transactions.
• The Authorization must indicate the NPI, Taxonomy code and Zip+4 (9 digit zip code) that Medicaid has received and approved for each of your Medicaid Billing Provider Numbers used in electronic transactions. NPIs are still expected for all other provider identifiers.
Currently, Nebraska Medicaid is accepting claims with the only the NPI information being reported in the billing provider section. However in order to be 5010 compliant, providers must now report the NPI, Taxonomy Code and the Nine Digit Zip Code in order for claims to be accepted at the payer level. This information must match the data on file for each provider with Nebraska Medicaid.
Action Required: Providers need to work with Nebraska Medicaid to determine the correct NPI, taxonomy code, and nine digit zip code to be reported as the Billing Provider. These changes can be implemented now.
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Give us a call at 877.480.6517 for more information.