MedicaidAdministrativeHigh impact
[Indiana] NPI for Service and Billing Provider on Professional Claims Submission
CareSource·IN·Claims & Billing
Effective date
Feb 2, 2026
We identified it
May 9, 2026
Summary
CareSource Indiana (Medicaid and Marketplace) now requires that the Service Facility Location NPI (Box 32a on paper claims, Loop 2310C on 837 files) be reported ONLY when it differs from the Billing Provider NPI. Claims submitted with identical NPIs for both fields will be rejected and not processed, causing reimbursement delays.
Action Required
By February 2, 2026 (immediately): Billing team must audit and update all claim submission processes to ensure Service Facility Location NPI and Billing Provider NPI are never the same on professional claims. (1) Review practice management/billing system configuration for Box 32a (paper) and Loop 2310C NM109 (837 EDI) to prevent duplicate NPI entry. (2) Update any templates, batch processes, or direct data entry workflows in the CareSource Provider Portal to validate that these fields contain different NPIs before submission. (3) Train billing staff to verify NPI differentiation during claim preparation and review. (4) Test claim submissions with sample data before the effective date. Consequences: Claims with matching NPIs will be rejected and not processed, delaying patient reimbursements and impacting cash flow. Contact CareSource Medicaid (1-844-607-2831) or Marketplace (1-833-230-2101) with questions.