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Oregon Health Plan and your National Provider Identifier (NPI)
Learn how OHP providers need to use this number when doing business with DMAP. 
 

 OHP-Faqs

 
  
Answer
Do I need a National Provider Identifier (NPI)? 
All covered entities under HIPAA (i.e., health care service providers) must use NPIs in standard HIPAA transactions. Atypical service providers (e.g., non-emergent transportation service providers) are not subject to NPI requirements.
 
Only DMAP providers with an NPI linked to their Oregon Medicaid provider number can access the Provider Web Portal.
 
All providers must submit NPI information, if applicable, in order to enroll as a DMAP provider.
How do I get an NPI? 

Follow the directions on the National Plan and Provider Enumeration System (NPPES) website. Enrolled DMAP providers should notify Provider Enrollment, (800-422-5047), when they have changes or additions to their NPI and taxonomy information. Include your Oregon Medicaid provider number, NPI and the taxonomy code(s) you selected.

Do I need taxonomy codes? 
If you are a provider that has one NPI and multiple Oregon Medicaid provider numbers, a unique taxonomy code for each provider number is preferred. If this isn't possible, then DMAP will need a unique name, address or ZIP+4 for each provider number. This allows DMAP to make a positive one-to-one match between each Oregon Medicaid provider number and your unique NPI.
 
If you have only one Oregon Medicaid provider number, then you do not need to use a taxonomy.
How do I enter NPI information on claim submissions? 
On electronic data interchange submission, use the NPI and taxonomy DMAP has on file for your Oregon Medicaid provider number. On paper submissions, enter the NPI and Oregon Medicaid provider number.
 
If the NPI information on the claim does not match what DMAP has on file for the Oregon Medicaid provider number used for billing, DMAP will try to link the claim to the correct NPI by matching the provider name, address, ZIP+4 or other identifying information.
How do I find out what DMAP has on file for my NPI information? 

Contact Provider Enrollment, (800-422-5047). Provide your Oregon Medicaid provider number.

How can I find out which NPI and taxonomy codes I chose? 

Call the NPI Enumerator at 800-465-3203, or look it up in the online NPI Registry.

What if I have more than one NPI?
If you have more than one NPI but only one Oregon Medicaid provider number, DMAP must add new Oregon Medicaid provider numbers for the additional NPIs.
 
Registered Oregon Medicaid trading partners must contact EDI Support Services (888-360-9888) whenever they obtain additional Oregon Medicaid provider numbers. Include the following information:
  • Your trading partner ID
  • New provider number(s)
  • The NPI and Oregon Medicaid provider number currently associated with your trading partner ID.
EDI Support will be able to link your new Oregon Medicaid provider number(s) with your trading partner ID so that your Electronic Remittance Advice (835) gets created when you bill using the new number(s).
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