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National Provider Identifier (NPI)

NPI requirements for MassHealth providers

The Administrative Simplification requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates that healthcare providers acquire and use an NPI.  NPIs are 10-digit numbers that uniquely identify healthcare providers. Providers use NPIs to identify themselves to any health insurance company in the United States.

If you are a healthcare provider as defined by the federal Centers for Medicare & Medicaid Services (CMS), you need to have an NPI.  The only providers that are excluded from obtaining an NPI are atypical providers, such as rest homes, non-emergency transportation providers, wig providers, and certified mastectomy fitters. 

MassHealth and NPIs

Each provider's NPI is associated in MassHealth’s Medicaid Management Information System (MMIS) with a corresponding MassHealth provider ID and service location (PID/SL). This PID/SL is 10 characters, made up of a 9-digit base number and an alpha service location (e.g. 1234567 89A). The provider’s PID/SL will be displayed on MassHealth reports as well as correspondence and remittance advices. 

Providers who bill MassHealth are required to submit NPIs on all of their claims. Claims billed without a billing provider’s NPI will be denied.

MassHealth processes claims by mapping the NPI submitted on a claim to the MMIS provider number. As some providers may have one NPI that corresponds to multiple service locations, and therefore multiple MMIS provider numbers, MassHealth may require a taxonomy code for claims submission.  You do not need to use a taxonomy code for billing unless you have been instructed to do so by the MassHealth Customer Service Provider Enrollment Unit.

Apply for an NPI

Providers can apply for NPIs at the National Plan & Provider Enumeration System (NPPES) website. 

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