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Nebraska Medicaid NPI. NE Medicaid is in the process of procuring a new NPI compliant Medicaid Management Information System (MMIS) claims processing system. This system will not be implemented prior to the May 23, 2007, NPI implementation date. Nebraska Medicaid NPI.

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nebraska medicaid npi

Nebraska MedicaidNPI

NE Medicaid is in the process of procuring a new NPI compliant Medicaid Management Information System (MMIS) claims processing system. This system will not be implemented prior to the May 23, 2007, NPI implementation date.

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Nebraska MedicaidNPI

Nebraska’s NPI interim solution is to be able to accept the NPI, but to continue to require the legacy Medicaid provider Number and other legacy identifiers, such as the Social Security Number (SSN) and State License Number, in the 837 transactions in order to process claims and make payment.

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Nebraska MedicaidNPI

Nebraska Medicaid expects to be able to accept the NPI prior to 5/23/2007, but does not plan to be fully compliant until the new MMIS is installed.

  • As of September 8, 2006 can accept NPIs from Trading Partners.
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Nebraska MedicaidNPI

Prior to submitting any NPIs each Trading Partner must complete testing.

  • We require two successful files of no more than 20 – 25 claims each.
  • You must contact the EDI Help Desk prior to submitting NPIs or any test files.
  • When you are ready to test, contact the EDI Help Desk to schedule NPI testing at medicaid.edi@hhss.ne.gov or 1-866-498-4357.
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Nebraska MedicaidNPI
  • Until the installation of an NPI compliant MMIS, only the 837I, 837P, 837D and 835 will accept or send the NPI, along with legacy identifiers.
  • Changes to all other transactions are not planned at this time.
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Nebraska MedicaidNPI

837 P

Billing Provider Loop 2010AA

NM 108 XX

NM 109 NPI REF 01 1D

REF 02 Medicaid Provider Number

REF 01 EI or SY

REF 02 EIN or SSN

Nebraska Medicaid Directive: Use code “1D” and

the 11-digit NE Medicaid assigned provider number. If Billing Provider NPI is sent in NM109, Nebraska Medicaid requires on additional REF segment using Employer Identification Number (EI) or Social Security Number (SY).

nebraska medicaid npi7
Nebraska MedicaidNPI

837 P

Referring Provider Loop 2310A

NM 108 XX

NM 109 NPI

REF 01 0B REF 02 State License Number

Nebraska Medicaid Directive: Use code "0B".

0B State License Number

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Nebraska MedicaidNPI

837 P

Rendering Provider Loop 2310B

NM 108 XX

NM 109 NPI

REF 01 SY REF 02 SSN

Nebraska Medicaid Directive: When using NPI

(XX) or Employer Identification Number (24),

Nebraska Medicaid requires a REF segment with

Social Security Number (SY) as a secondary ID.

slide9

Nebraska MedicaidNPI

837 I

Billing Provider Loop 2010AA

NM 108 XX

NM 109 NPI REF 01 1D

REF 02 Medicaid Provider #

REF 01 EI or SY

REF 02 EIN or SSN

Nebraska Medicaid Directive: Use code “1D” and

the 11-digit NE Medicaid assigned provider number. If Billing Provider NPI is sent in NM109, Nebraska Medicaid requires on additional REF segment using Employer Identification Number (EI) or Social Security Number (SY).

slide10

Nebraska MedicaidNPI

837 I

Attending Physician Loop 2310A

NM 108 XX

NM 109 NPI

REF 01 0B REF 02 State License Number

Nebraska Medicaid Directive: Use code "0B".

0B State License Number

slide11

Nebraska MedicaidNPI

837 I

Attending Physician Loop 2310A

NM 108 XX

NM 109 NPI

REF 01 0B REF 02 State License Number

Nebraska Medicaid Directive: Use code "0B".

0B State License Number

slide12

Nebraska MedicaidNPI

837 I

Operating Physician Loop 2310B

NM 108 XX

NM 109 NPI

REF 01 0B REF 02 State License Number

Nebraska Medicaid Directive: Use code "0B".

0B State License Number

slide13

Nebraska MedicaidNPI

837 I

Other Provider Loop 2310C

NM 108 XX

NM 109 NPI

REF 01 0B REF 02 State License Number

Nebraska Medicaid Directive: Use code "0B".

0B State License Number

slide14

Nebraska MedicaidNPI

837 D

Billing Provider Loop 2010AA

NM 108 XX

NM 109 NPI REF 01 1D

REF 02 Medicaid Provider Number

REF 01 EI or SY

REF 02 EIN or SSN

Nebraska Medicaid Directive:

Nebraska Medicaid requires use of code 1D and the 11-digit NE Medicaid assigned provider number. If Billing Provider NPI is sent in NM109, Nebraska Medicaid requires an additional REF segment using either Employer Identification Number (EI) or Social Security Number (SY).

slide15

Nebraska MedicaidNPI

837 D

Rendering Provider Loop 2310B

NM 108 XX

NM 109 NPI REF 01 0B

REF 02 State License Number

REF 01 SY

REF 02 SSN

Nebraska Medicaid Directive:

Nebraska Medicaid requires use of 0B and State License Number. If Rendering Provider NPI is sent in NM109, Nebraska Medicaid requires an additional REF segment using Social Security Number (SY).

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Nebraska MedicaidNPI

835

Loop 1000B

N104 Federal Tax ID

REF02 1D Medicaid Provider ID

Loop 2100

NM109 NPI*

*when sent to Nebraska Medicaid on an 837 transaction and = 10 digits & all numeric

slide17

Nebraska MedicaidNPI

Paper Claims

  • NPI will be optional on the new CMS 1500 and UB claim forms
  • You may enter the NPI but Nebraska Medicaid will continue to require the legacy Medicaid Provider Number and other legacy identifiers (SSN and state license number) to process claims and make payment.
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Nebraska MedicaidNPI
  • For questions about NPI

Deb Scherer at 402-471-0122

deb.scherer@hhss.ne.gov

  • EDI HelpDesk – for NPI testing

1-866-498-4357

medicaid.edi@hhss.ne.gov