New Requirement to Use Individual Practitioner NPI and Modifiers
Date: 05/22/18
Effective July 1, 2018, The Ohio Department of Medicaid (ODM) and Buckeye Health Plan (Buckeye) will require the following provider types to submit claims with the Rendering Provider NPI and appropriate procedure Modifiers:
- Federally Qualified Health Center FQHC- Provider Type 12
- EXCEPTION: Transportation Services
- Rural Health Center RHC- Provider Type 4
- Outpatient Health Facility OHF- Provider Type 5
- Ambulatory Health Care Clinic AHCC- Provider Type 50
- EXCEPTION: Provider is not a licensed professional
- EXCEPTION: When the services listed below are performed by general/technical staff rather than licensed professionals, a rendering provider will not be required
- Radiology & Laboratory
- DME
- Freestanding Birth Center FBC- Provider Type 11
For Dates of Service July 1, 2018 and after, Buckeye will deny claims submitted without an Individual NPI reported in the rendering provider field.
Additionally, please ensure modifiers are submitted for services or supplies where applicable. Buckeye will adjudicate claims according to industry standard guidelines.
For more details regarding these requirements please go to:
http://medicaid.ohio.gov/Portals/0/Resources/Publications/Guidance/MedicaidPolicy/NonInst/MAL622.pdf
Please contact Buckeye Provider Services at 1-866-296-8731 with any questions.