Maryland Medicaid: Unique NPI numbers required for each practice location

In an effort to streamline provider enrollment and reduce the amount of claim denials, Maryland Medicaid is implementing a new policy that requires practices to have unique National Provider Identifier (NPI) numbers for each location. This update aligns with Centers for Medicare & Medicaid Services (CMS) guidance and aims to mirror our billing system with the state’s enrollment system. You can find complete policy details in section 7 of the 2024 Winter General Provider Updates.

What you need to do

Obtain unique NPI numbers for each location. Already enrolled providers impacted by this policy change will be notified when they need to update their current Maryland Medicaid Provider accounts. Please do not attempt to update your existing accounts until you receive the notification. Apply for and obtain additional NPI numbers from the National Plan and Provider Enumeration System (NPPES) or by calling at 800-465-3203 or 800-692-2326 (NPI TTY).
You do not need to submit any applications in ePREP to update your accounts. Instead, once the spreadsheet is received with the new NPIs, MDH will update their billing and enrollment systems for you. After each update you will receive an email that it has been completed from our official correspondence address, mdh.npiuncollapsing@maryland.gov.

Once you receive registration confirmation from the state, you can use the new NPI number(s) for your service facility NPI on claims. Please also be sure your billing NPI number and location address, including the ZIP code+4, match what’s in the state’s ePREP system as your active record.

Why this change is being made

Currently in ePREP, not all practices have a unique NPI number when they enroll multiple health care sites. This means that tracking services by a specific location isn’t possible. In addition, when a practice address’s ZIP code doesn’t match the state’s ZIP code information, claims are often denied.

Exceptions

Hospitals are excluded from the new NPI policy and can continue to share the same NPI number across hospital enrollments. Additionally, this requirement does not apply to providers with a Type 1 Individual NPI number.