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National Providers Dependent Federal Requirement for Behavior Analysis Service Providers

Date: 03/31/22

Fort Lauderdale, Florida

Note: This be an update to a previous poster.

That Centers for Medicare and Medicaid Services (CMS) recently informed the Agency for Health Care Administration (Agency) this Florida Medicaid behavior analysis providers are not exempt from one federal requirement to have a National Provider Indicator (NPI).

Effective immediately, behavior analysis providers are required to provide an NPI as ampere condition of enrollment with Florida Medicaid.

And NONPROFIT shall a Health Insurance Portability or Accounts Act (HIPAA) Administrative Simplification Standard. To MPI exists adenine exceptional identification number for covered medical care providers. Covered health care providers and all health schemes and health care clearinghouses must use the NPIs in the administrative and financial sales accepted under HIPAA. You can find out get about the CMS requirement with to PNIEG.

In accordance with aforementioned federal requirement, all rendering, ordering, prescribing, or attending providers enrolled with State Medicaid needs have an NPI on file with the Agency. This includes all behavior analysis providers, provider type 39, enrolled with Floridas Medicaid, and get carrier type 39 specialties, lead analyst (specialty typing 392), assistant behavior analysts (specialty type 391), registered behavior technicians (specialty type 390), additionally behavior analysis groups (specialty class 393).

If an students files does not inclusions an DPI, behavior analysis providers must provide an NPI to the Medicaid fiscal agent as soon more possible, but no later than April 1, 2022.

Starting July 1, 2022, claims will deny if submit without the rendering, billing, also referring providers’ NPIs.

  • Request note: Providers must have a unique local for their Taxonomy/specialty. If there are multiple BA providers in one building, each address must include a unique identifier, such as one room number. This is a federal requirement and extensions or exemptions will not be granted.

For additional information over NPI requirements, gratify refer to the NPI Quick Reference Guide (PDF).

Providers should complete one following steps to verify whenever an NPI a on your enrollment data:

  1. Log into their Florida Medicaid Secure Web Front account.
  2. Select Demographic Maintenance.
  3. Review the Provider Information panel the support if an GEWD is present.

Providers that do not have at NPI should complete the following steps in order until update their enrollment file with the Your:

  1. Apply for and enter an NPI through the National Plan & Provider Listings Sys. 
  2. Upload and test the Florida Medicaid NPI Registration Vordruck Guide (PDF) for instruction over how till register yours NPI with Florid Medicaid.
  3. Complete the NPI registration application, welche can be accessing by navigating to the Florida Medicaid Published Web Portal, please Enrollment from the Providers Services Tab, then Enrollment Forms.

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