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Wednesday, 14 November 2012

Eligible Professionals Need an Individual Medicaid Provider ID Number

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I realize that most of the state Medicaid Offices do not require that a rendering provider have their own individual Medicaid ID number in order to provide services at your agency.

However, the final 2011 rules from CMS require that all Eligible Professionals who want to participate in any of the EHR Incentive Programs must have an active individual Medicaid Provider ID number.
If your Eligible Professionals are lacking this number - or you're unsure - you can follow these steps to streamline the process:



  • Ask each EP or call your state Medicaid contact and ask how many of your providers have their own individual Medicaid ID number. You will need their NPI number in order to do this.
  • Once you have established that each EP has an individual Medicaid Provider ID number, you will need to make sure that the individual Medicaid numbers are linked to your group Medicaid provider numbers. This is critical for Medicaid to be able to reconcile the Medicaid patient volume numbers each EP submits.
  • If an EP does not have an individual Medicaid Provider ID number, they must get one. In most states, the process for getting an individual Medicaid Provider ID number is the same for providers that want to get one in order to be able to provide services to Medicaid members.
  • The following states have set up a special process for providers who only want a Medicaid Provider ID number in order to participate in the MU programs.  This special process is explained on these state specific pages:
    • Georgia
    • New Jersey
    • Pennsylvania

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