MedicaidAdministrativeHigh impact
p 033940
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Jan 1, 2013
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires National Provider Identifier (NPI) numbers to be reported on ALL claim submission types including paper, internet, and electronic claims. Previously, NPIs were only required on electronic HIPAA-covered claims, but this expansion mandates NPI reporting across all claim formats with specific field requirements for each form type.
Action Required
By January 1, 2013: Billing team must ensure all Pennsylvania Medicaid claims include required NPI numbers in specified fields - Field 33a (Billing Provider NPI) on CMS-1500 forms, Field 56 (Billing Provider NPI) and Field 76 (Attending Physician NPI) on UB-04 forms, and Fields 49 and 54 on ADA 2006 forms. Update billing software to validate NPI presence before claim submission. Register all provider NPIs with Pennsylvania Department of Public Welfare. Claims missing required NPIs will be denied starting January 1, 2013.