How To Register A National Provider Identifier (NPI)

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How to register a National Provider Identifier (NPI)For use by behavioral health providers to assist in the transition to Integrated Managed Care (IMC).In order for clinicians to be Washington Apple Health (Medicaid) providers, they must enroll theirNational Provider Identifier (NPI) numbers with the Health Care Authority (HCA). This fact sheetprovides basic information on NPIs, including where clinicians can get more information and enroll theirNPIs with HCA.For more information, visit www.hca.wa.gov/enroll-as-a-provider .Application and enrollment of an NPI with HCAHow do providers apply for an NPI?Providers can apply for an NPI from the National Plan and Provider Enumeration System (NPPES),managed by the federal government. For more information, on the National Provider Identifier Standardand how to apply for an NPI, visit eSimplification/NationalProvIdentStand/ .Why do providers have to enroll their NPIs with HCA?The Centers for Medicare and Medicaid Services (CMS) requires all health care providers servingMedicaid clients to have their NPIs registered with their state Medicaid agency.Which NPIs must be enrolled with HCA?There are two types of NPIs that must be enrolled with HCA:1) Individual NPI: This is the NPI of the individual provider delivering health care services2) Organizational NPI: This is the NPI of the behavioral health agency where the individual worksHistorically, behavioral health providers in Washington State have primarily used their organizationalNPI when billing for services under the Medicaid program. With the transition to Integrated ManagedCare (IMC), clinicians will also need to enroll the individual providers’ NPI as a non-billing provider withHCA, and include that NPI on encounter data submissions. A non-billing provider is often also referred toas a “servicing only” provider.What is the difference between billing and non-billing?A billing provider is a health care provider that wishes to participate in fee-for-service (FFS) and/or willbe submitting claims under their own NPI for reimbursement. In Washington, unless the provider is asole proprietor, most behavioral health agencies use their organizational NPI as the billing NPI.November 20181

A non-billing provider is a provider who will not be submitting claims for reimbursement under theirown NPI, but still wishes to enroll in Medicaid for the sole purpose of ordering, referring, and prescribingservices. This is also known as a servicing-only provider. In Washington, most individual cliniciansemployed at behavioral health agencies enroll their individual NPI as non-billing providers.How do providers enroll their NPIs?Clinicians not already enrolled as Medicaid providers will enroll their NPIs as part of the Medicaidprovider enrollment process. Typically, the employing agency will enroll their employee clinicians.Agencies must follow HCA’s guidelines to prepare for the enrollment process and then use theProviderOne billing and claims system to complete the enrollment application. For more information onthe enrollment process, as well as step-by-step instructions on how to complete the enrollmentapplication, visit www.hca.wa.gov/enroll-as-a-provider .When do providers need to have their NPIs enrolled with HCA?All behavioral health providers in the Integrated Managed Care (IMC) regions should have their NPIsenrolled with HCA prior to the date of IMC implementation in their region. HCA encourages providersto enroll NPIs as soon as practicable.How do providers know which taxonomy code to enroll under?Providers should enroll under the taxonomy that is most appropriate to their credentialing or licensure.Please see the below table for a crosswalk of 2-digit SERI provider types to 9 - digit taxonomy codes.Please note for the following list of taxonomy codes, clinicians must also enroll their NPI with HCA usingthe NPPES taxonomy code, and should always use the NPPES taxonomy when submitting claims orencounters to a clearinghouse or MCO. This applies to: 101Y99993L, 101Y99994L, 101Y99995L,101Y99996L.SERI PROVIDERTYPESDOH LICENSE (IFAPPLICABLE)HCA TAXONOMY CROSSWALK01 RNRegistered Nurse163W00000X - Registered Nurse01 LPNLicensed Practical Nurse164W00000X - Licensed PracticalNurse02 ARNPARNP363LP0808X - Psych, Mental HealthARNP02 PAPhysician Assistant363A00000X - Physician Assistant03 Psychiatrist/MD4Psychiatrist (Physician)2084P0800X - Psychiatry &NeurologyTAXONOMY NOTESHCA recognizes 18subspecialties forARNP'sHCA recognizes threesubspecialties for PA'sHCA recognizes 5subspecialties forPsychiatrists2

Social Worker Advance License04 MA/PhD (licensed)Social Worker IndependentClinical LicenseMarriage and Family TherapistLicense104100000X - Social Worker104100000X - Social Worker106H00000X - Marriage and FamilyTherapistMental Health CounselorLicenseMental HealthCounselorLicensed PsychologistnewCounselor Certified CertificationLicensed Psychologist101YM0800X – Mental HealthCounselor103T00000XMA/PHD (nonlicensed)- new101Y99996L - MA/PHD (nonlicensed)05 Below MastersDegree101Y99995L - MH & CDPT intraining; crosswalk with SERI types05, 09, 10, 12, 2106 DBHR CredentialedCertified PeerCounselor175T00000X - Peer Specialist09 Bachelor Level withException/Waiver101Y99995L - MH & CDPT intraining; crosswalk with SERI types05, 09, 10, 12, 21Both DOHcredentialedcounselor types areenrolled under thesame taxonomy; onlydifference beingcounselor's with thecertified certificationcannot be enrolled asa sole proprietorunder FFS; should notimpact the IMCimplementationHCA recognizes 16subspecialties ofPsychologistsProviders using thistaxonomy must alsoenroll their NPPEStaxonomy with HCAand should always usethe NPPES taxonomywhen submitting to aclearinghouse orMCO.Providers using thistaxonomy must alsoenroll their NPPEStaxonomy with HCAand should always usethe NPPES taxonomywhen submitting to aclearinghouse orMCO.Providers using thistaxonomy must alsoenroll their NPPEStaxonomy with HCA3

10 Master Level withException/Waiver101Y99995L - MH & CDPT intraining; crosswalk with SERI types05, 09, 10, 12, 2112 Other (ClinicalStaff)101Y99995L - MH & CDPT intraining; crosswalk with SERI types05, 09, 10, 12, 2114 Non-DBHRCredentialed CertifiedPeer Counselor175T99994L - Non-DBHR CertifiedPeer Counselor; crosswalk withSERI type 14101Y99993L - Medical Assistant Certified; crosswalk with SERI type1515 Medical Assistant –Certified16 PharmDPharmacist License183500000X - Pharmacist20 ChemicalDependencyProfessionalChemical DependencyProfessional Certificate101YA0400X - ChemicalDependency Professional (CDP)21 ChemicalDependencyProfessional TraineeChemical DependencyProfessional Trainee Certificate101Y99995L - MH & CDPT intraining; crosswalk with SERI types05, 09, 10, 12, 21and should always usethe NPPES taxonomywhen submitting to aclearinghouse orMCO.Providers using thistaxonomy must alsoenroll their NPPEStaxonomy with HCAand should always usethe NPPES taxonomywhen submitting to aclearinghouse orMCO.Providers using thistaxonomy must alsoenroll their NPPEStaxonomy with HCAand should always usethe NPPES taxonomywhen submitting to aclearinghouse orMCO.Providers using thistaxonomy must alsoenroll their NPPEStaxonomy with HCAand should always usethe NPPES taxonomywhen submitting to aclearinghouse orMCO.HCA recognizes 7subspecialties ofPharmacistsProviders using thistaxonomy must alsoenroll their NPPEStaxonomy with HCAand should always usethe NPPES taxonomywhen submitting to a4

clearinghouse orMCO.Is there a batch process for large agencies?To enroll 200 non-billing providers at the same time, a batch process may be possible by contacting theHCA Provider Enrollment Manager at george.wagner@hca.wa.gov .Can the MCOs submit NPI enrollment on behalf of providers?No, managed care organizations cannot enroll NPIs on behalf of providers. However, behavioral healthagencies can and typically do enroll their employee clinicians.Where can I get more information about the provider enrollment process?For more information, contact HCA: Online: www.hca.wa.gov/enroll-as-a-providerEmail: providerenrollment@hca.wa.govPhone: 1-800-562-3022 (extension 16137)5

20 Chemical Dependency Professional Chemical Dependency Professional Certificate 101YA0400X - Chemical Dependency Professional (CDP) 21 Chemical Dependency Professional Trainee Chemical Dependency Professional Trainee Certificate 101Y99995L - MH & CDPT in training; crosswal

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