Wisconsin Medicaid will not implement the National Provider Identifier (NPI) on May 23, 2007. Providers are required to continue to indicate their eight-digit Medicaid provider number on all electronic and paper claims and other transactions (e.g., prior authorization) submitted to Wisconsin Medicaid on and after May 23, 2007. Claims submitted without an eight-digit Medicaid provider number will be denied. This requirement will continue until providers are notified otherwise in a future Wisconsin Medicaid and BadgerCare Update.

Providers may include their NPI on electronic (837 transactions) and paper claims submitted to Wisconsin Medicaid; however, the NPI will not be used for processing. For proper processing, providers must continue to include their proprietary, eight-digit Medicaid provider number.

Providers who submit claims to Wisconsin Medicaid using the National Council for Prescription Drug Programs (NCPDP) transactions must continue to indicate their eight-digit Medicaid provider number.

Providers who submit claims to Wisconsin Medicaid using the free Provider Electronic Solutions (PES) claims submission software must continue to indicate their eight-digit Medicaid provider number. The software is not being modified at this time to accommodate the inclusion of the NPI.

Note: This information is specific to Wisconsin Medicaid and SeniorCare. Other payers may have different requirements.

Information Regarding Medicaid HMOs

This Update contains Medicaid fee-for-service policy and applies to providers of services to recipients on fee-for-service Medicaid only. For Medicaid HMO or managed care policy, contact the appropriate managed care organization. Wisconsin Medicaid HMOs are required to provide at least the same benefits as those provided under fee-for-service arrangements.