National Provider Identifier
Getting an NPI is free; not having one can be costly.
All providers of health care-related services must submit EDI transactions to DMAP using their NPI. For more information, see the Frequently Asked Questions page, or go to the Centers for Medicare and Medicaid Services Web site.
- If you have questions about how to use NPI in your transactions with DMAP, contact EDI Support Services at 888-690-9888 or DHS.EDIsupport@state.or.us.
- If you have questions about how to update your provider record with correct NPI and taxonomy information, contact DMAP Provider Enrollment at 800-422-5047 or e-mail email@example.com
- If you have questions about using your NPI on paper claims, contact DMAP Provider Services at 800-336-6016 or e-mail firstname.lastname@example.org
Apply for your NPI with NPPES
To get an NPI, apply online at the National Plan and Provider Enumeration System (NPPES) website, free of charge. You can also call 800-465-3203 to request a paper application.
NPI and your Oregon Medicaid provider number
All providers of health-care-related services with a current 6- or 9-digit Oregon Medicaid provider number must provide DMAP their 10-digit NPI. This information is also required when enrolling as an Oregon Medicaid provider.
- If you have one NPI and more than one Oregon Medicaid number, also provide taxonomy and unique name, address, and ZIP+4 information for each Oregon Medicaid number. Atypical providers, such as transportation services, do not use NPI.
- If you have more than one NPI and only one Oregon Medicaid number, you may need to have additional Oregon Medicaid numbers.
To verify or update your NPI and taxonomy information, contact DMAP Provider Enrollment (800-422-5047).
Use NPIs on all electronic transactions submitted to DMAP
If you are required to use an NPI, you must send electronic transactions to include your NPI. DMAP is NPI-compliant for all transactions.
- If you send DMAP a claims transaction (837I 837P, 837D, or NCPDP) with a non-NPI identifier in any of the provider fields, your claim will deny for payment; other transactions may not process.
- Refer to the Oregon MMIS Technical Specifications for specific information on where to enter your NPI(s) for each transaction exchanged with DMAP.
|Billing Provider ID
||If your billing software is set up to send both the NPI and the non-NPI identifier(s), and your clearinghouse or billing service will not be stripping the legacy identifier from your claim, you must do one of the following:
- Make sure to strip and submit the electronic claim with NPI only (i.e., with NO legacy identifiers), or
- Submit the claim on paper.
|Secondary Provider ID
||If you have to supply secondary provider information (e.g., the ordering/ referring/ attending/operating provider, service facility location, or prescriber) and do not furnish an NPI in the secondary provider field, you must attempt to obtain that NPI in order to enter it on the claim.
The billing provider may use the NPI Registry or directly contact the secondary provider to obtain the NPI.
DMAP will follow Medicare's process as follows, when you have exhausted all possibilities of finding the NPI and still cannot find the NPI:
- For referring, rendering or prescribing provider loop: The billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) can use their own NPI here.
- For service facility location loop: Do not report an identifier in this loop.