Ohio Medicaid is updating its claims payment system to require the inclusion of individual rendering provider NPIs on clinic claims. This work is necessary to implement a federal requirement. The projected implementation date of this systems work is Sunday, July 1, for Ohio Medicaid and its Medicaid managed care plans.
This systems work will change how clinics currently report NPIs in the Rendering Provider fields of Medicaid claims. Currently, clinics list their billing NPI in the rendering field. Effective Sunday, July 1, clinics will report individual NPIs in the Rendering Provider fields with the applicable procedures on claims. This change will also mean that individual providers working at clinics will need to enroll with Medicaid, and then affiliate themselves with the clinic. Information on how to affiliate individual providers to your clinics can be obtained through Medicaid’s Provider Enrollment area by calling 800.686.1516.
You may also need to reach out to your vendor to update your system for this change.
Federally-qualified health clinics (FQHCs) and Rural Health Clinics (RHCs) are also impacted by this change.
Melissa Little, MA, MHA, MLHR
Medicaid Health Systems Administrator 2
Non-Institutional Policy/Bureau of Health Plan Policy
The Ohio Department of Medicaid