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:
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.
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.