National Provider Identification Number Guidance

The National Provider Identifier (NPI) is a Federally-issued 10-digit unique standard identification number that all Health Care Providers must use when submitting electronic claims effective May 23, 2008.

Electronic claims submitted without an NPI will be rejected back to the provider via their EDI clearinghouse. Network Providers who submit claims via paper CMS 1500 or UB-04 are also required to include their NPI on their claims.

At this time, Keystone Mercy strongly encourages Network Providers to continue to submit claims with their Keystone Mercy provider ID, in addition to the required NPI number.

How to Apply for Your NPI

Health Care Providers may apply for their NPI in one of the following ways:

• Complete the web-based application at https://nppes.cms.hhs.gov. This process takes approximately 20 minutes to complete.
• Call the Enumerator call center at 1-800-465-3203 or TTY 1-800-692-2326 to request a paper application.
• E-mail customerservice@npienumerator.com to request a paper application.
• Request a paper application by mail:
  NPI Enumerator
  P.O. Box 6059
  Fargo, ND 58108-6059

Note: The most time-efficient method of getting an NPI is the web-based application process.

Reporting your NPI(s)

Network Providers must report their practice and individual NPIs to us in order to record them in the claims processing system. Once the practice and individuals in the practice have obtained an NPI, the following four steps to report NPIs to Keystone Mercy should be completed.

1. Use the submission form to report practice and individual NPIs. The submission form includes information specific to a practice, as well as a listing of individual participating practitioners at the office location.  The submission form can be found in the Provider Center at www.keystonemercy.com. For a printed copy, please call 1-800-521-6007.
2. Report the corresponding Primary Provider Taxonomy Code for the practice and each individual participating practitioner at the office location as reported on the NPI application(s). The Provider Taxonomy code, a 10-character alphanumeric identifier, indicates provider specialty and will assist Keystone Mercy in verifying NPIs for Claims processing.  Information on Provider taxonomy codes is available at www.wpc-edi.com/taxonomy.
3. Attach copies of NPI confirmation, issued to the practice and each individual participating practitioner at the office location, by the National Provider Identifier Enumerator. Keystone Mercy will use the NPI confirmation for verification purposes.
4. Return the completed submission form, along with practice and individual NPI confirmations via fax to 866-426-7671 or by mail:
   Attention: NPI - 100
   Keystone Mercy Health Plan
   200 Stevens Drive
   Philadelphia, PA  19113

You may also submit your NPI electronically to Keystone Mercy. Visit the Provider Center at www.keystonemercy.com and click on the NPI on-line submission tool.

Additionally, Providers participating with Keystone Mercy must participate in the Pennsylvania Medical Assistance Program. The Department of Public Welfare (DPW) also requires that Providers obtain an NPI and share it with them. Further information on DPW's requirements can be found at www.dpw.state.pa.us.