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Subject: Missouri Medicaid Provider Enrollment
and Billing Changes
Source: Shelley Witherbee, Supervisor, Funds Management
Intended Audience: School Administrators and Directors of Special Education
Date: November 3, 2006
The Provider Enrollment Process for Missouri Medicaid is changing due to the
implementation of the National Provider Identifier (NPI) Plan. The
transition to the new process will be effective January 1, 2007, and will
change the way districts enroll and bill for Medicaid. The transition will
be a two-step process on both the state and federal level. Districts and
therapists must complete both steps in order to participate in the Medicaid
program for Direct Services. An NPI will be required for both the district
and the individual therapist.
STEP ONE: DISTRICT TO ENROLL AS A CLINIC/GROUP PROVIDER
All school districts that are not enrolled in the Medicaid program will have
to enroll as a "Clinic/Group" provider if they wish to bill for services.
Districts currently enrolled as Occupational, Speech, and/or Physical
Therapy providers will automatically be assigned a Medicaid "Clinic/Group"
provider number. On and after January 1, 2007, the old provider numbers
assigned for Occupational, Speech, and Physical therapies to districts may
no longer be used. Districts will use the new Clinic/Group number as the
billing provider number for all therapy and psychology services. The
Clinic/Group number will begin with "50" (for example-506086601). A letter
was sent on October 23, 2006, to your superintendent indicating the change
and supplying the new Clinic/Group provider number. The Clinic/Group number
is located under the date on the letter. To see if your district is already
an enrolled provider, go to:
http://www.dss.mo.gov/dms/providers.htm and click on "Medicaid Provider
Search" in the left hand column. Districts that are NOT currently enrolled
as a provider must complete an on-line application at:
http://peu.momed.com/momed/presentation/commongui/PeHome.jsp.
Instructions for completing the enrollment application are on the Funds
Management webpage at:
http://www.dese.mo.gov/divspeced/Finance/medicaid.html.
After the district enrolls with MO Medicaid on the state level, they will
need to apply for an NPI number on the federal level. Districts may enroll
for their NPI number at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do then click on "National
Provider Identifier (NPI)." Follow the instructions to complete the NPI
enrollment process.
STEP TWO: THERAPISTS TO ENROLL AS INDIVIDUAL "PERFORMING" PROVIDERS
The next step will involve each individual therapist enrolling as a provider
if they are not already enrolled. This must be done in addition to the
district enrollment as Clinic/Group provider. This number will be coded as
the performing provider number when billing.
Therapists who already have an active provider number do NOT need to enroll
again. Therapists may enroll on-line at:
http://peu.momed.com/momed/presentation/commongui/PeHome.jsp. To see if
a therapist is already an enrolled provider, go to:
http://www.dss.mo.gov/dms/providers.htm and click on "Medicaid Provider
Search" in the left hand column. Individuals with a Speech and Language
Specialist Teacher's Certification through DESE must also enroll as a
provider. After the therapist enrolls with MO Medicaid on the state level,
they will need to apply for an NPI number on the federal level.
Therapists may enroll for their NPI number at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do then click on "National
Provider Identifier (NPI)." Follow the instructions to complete the NPI
enrollment process. The individuals with Speech and Language Specialist
Teacher's Certification through DESE will not apply for an NPI number.
They will be assigned a pseudo-number by DMS in place of the NPI for billing
purposes.
Further instructions and training will be forthcoming from the Division of
Medical Services and the Department of Elementary and Secondary Education in
the near future. If you have any questions, please contact
shelley.witherbee@dese.mo.gov
or at (573) 522-2523.
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