North Carolina Medicaid Special Bulletin - Number 3 May 2008 - National Provider Identifier (NPI)

Sep 19, 2026

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North Carolina Medicaid Special Bulletin Number 3 (May 2008) provides guidance for all providers on the National Provider Identifier (NPI). It explains what the NPI is under HIPAA, how NPI maps to the Medicaid Provider Number (MPN) for claim adjudication, and which atypical providers do not receive NPIs. The bulletin also covers how to obtain NPIs, required reporting to N.C. Medicaid, relevant taxonomy and subparts, and operational impacts on remittance, status reports, electronic transactions, and claim submission.

LanguageEnglish

CategoryForms

FormatPDF

Pages10

Reading Time4 min

AccessFree to download

What is the National Provider Identifier?

The National Provider Identifier and N.C. Medicaid

Atypical Providers

Obtaining the National Provider Identifier

National Provider Identifier Subparts

National Provider Identifier and Provider Enrollment

Reporting the National Provider Identifier

Taxonomy and the National Provider Identifier

Unknown National Provider Identifier Report

Unresolved National Provider Identifier Report

The National Provider Identifier and the Automated Voice Response System

National Provider Identifier Effects on the Remittance and Status Reports and the 835 Transaction

National Provider Identifier and Claim Submission Guidelines

Electronic Mailing List for National Provider Identifier Updates

National Provider Identifier Implementation and Ready Letters

Notification of National Provider Identifier/Medicaid Provider Number Mismatch

Referring Provider Numbers for Carolina ACCESS Referral Authorizations

National Provider Identifier - Frequently Asked Questions

North Carolina Medicaid Special Bulletin An Information Service of the Division of Medical Assistance Visit DMA on the web at [http://www.ncdhhs.gov/dma](http://www.ncdhhs.gov/dma) Published by EDS, fiscal agent for the North Carolina Medicaid Program Number 3 May 2008 Attention: All Providers National Provider Identifier NPI– Get it! Share It! Use It! Getting one is free – Not having one can be costly! Table of Contents What is the National Provider Identifier? .................................................................................. 1 The National Provider Identifier and N.C. Medicaid ................................................................ 1 Atypical Providers ..................................................................................................................... 1 Obtaining the National Provider Identifier ................................................................................ 1 National Provider Identifier Subparts ........................................................................................2 National Provider Identifier and Provider Enrollment...............................................................2 Reporting the National Provider Identifier ................................................................................2 Taxonomy and the National Provider Identifier ........................................................................3 Unknown National Provider Identifier Report ..........................................................................3 Unresolved National Provider Identifier Report........................................................................4 The National Provider Identifier and the Automated Voice Response System.........................4 National Provider Identifier Effects on the Remittance and Status Reports and the 835 Transaction.................................................................................................................................4 National Provider Identifier and Claim Submission Guidelines................................................5 Electronic Mailing List for National Provider Identifier Updates .............................................5 National Provider Identifier Implementation and Ready Letters ..............................................5 Notification of National Provider Identifier/Medicaid Provider Number Mismatch ................6 Referring Provider Numbers for Carolina ACCESS Referral Authorizations ..........................6 National Provider Identifier – Frequently Asked Questions......................................................7 What is the National Provider Identifier? The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the adoption of a standard unique identifier for healthcare providers. The final rule for the National Provider Identifier (NPI), which was issued on January 23, 2004, adopts the NPI as this national standard and applies to all health care providers. The NPI is a 10-byte, all-numeric identifier that will replace all proprietary identifiers used in HIPAA-covered electronic transactions to identify a provider. The first character is a 1 or 2 and the last character is a check digit designed to help ensure validity of the number. There is no embedded intelligence in the NPI—it is simply a unique number to identify a provider regardless of the provider’s location, type, or specialty. The National Provider Identifier and N.C. Medicaid Effective January 1, 2008, all claims (except pharmacy claims and claims for atypical providers) submitted to N.C. Medicaid must contain the Medicaid Provider Number (MPN), NPI, and taxonomy. Like many other payers, N.C. Medicaid is adopting a mapping solution in which the NPI billed on the claim is mapped to the MPN for claims adjudication. This crosswalk method of matching the NPI to the MPN allows claims to process using current polic

FAQs

What is the National Provider Identifier (NPI) and what is its purpose?

The NPI is a 10-byte, all-numeric standard unique identifier required by HIPAA for healthcare providers. It replaces proprietary identifiers used in HIPAA-covered electronic transactions to identify a provider.

How does N.C. Medicaid use NPI when processing claims?

Claims submitted to N.C. Medicaid must include the Medicaid Provider Number (MPN), NPI, and taxonomy. N.C. Medicaid uses a mapping (crosswalk) approach to match the billed NPI to the correct MPN, ideally via a one-to-one match.

Who are “atypical” providers and do they receive NPIs?

Atypical providers do not provide healthcare services and will not be issued NPIs. They continue to use their legacy MPN for billing, even though they bill Medicaid for services rendered.

Sep 19, 2026

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