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Health Insurance Portability and Accountability Act (HIPAA) Update

National Provider Identifier (NPI)

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required the adoption of a standard unique identifier for health care providers. The National Provider Identifier (NPI) Final Rule issued January 23, 2004 adopted the NPI as this standard. The NPI is 10 digits in length and will replace the current Medi-Cal (Denti-Cal) provider number (legacy ID) in use today.

To comply with this requirement, the Centers for Medicare and Medicaid Services (CMS) developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. NPPES collects identifying information on health care providers and assigns each a unique National Provider Identifier (NPI). NPPES began accepting applications and issuing NPIs on May 23, 2005. All health care providers (e.g., dentists, physicians, suppliers, hospitals, etc.) are encouraged to obtain their NPI as quickly as possible.

When applying for an NPI, CMS urges providers to include their legacy ID for all payers (e.g., health insurance plans, State Medicaid agencies, Medicare). If reporting a Medicaid number, include the associated state name. This information is critical for payers in the development of crosswalks to aid the transition to the NPI.

Covered health care providers should have obtained an NPI by May 23, 2007. If you have not received an NPI, please contact the National Provider Identifier Enumerator.

Current Dental Terminology (CDT) - Transactions and Code Sets

Effective June 1, 2014, Denti-Cal began accepting Current Dental Terminology (CDT) Version 13 procedure codes. Claims and TARs submitted with dates of service on or after June 1, 2014 must utilize CDT 13 codes to ensure minimal disruption to the processing and payment of your documents

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