Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Medi-CalMedicaid · Documentation · Long Term Care · CA · GeriatricsHigh impact

Ordering, Referring and Prescribing: NPI Requirements for LTC Providers

Act
by Feb 1, 2027
Effective date
Feb 1, 2027
Identified
Oct 17, 2026

Summary

Effective February 1, 2027, Long Term Care (LTC) providers billing Medi-Cal must include both valid Attending and Referring provider NPIs (Type 1 Individual) on all claim forms, including UB-04. An Attending NPI is mandatory on all claims; both NPIs are required on initial, discharge, and transfer claims. Claims will be denied if NPIs are invalid, missing, inactive, or not Type 1 Individual NPIs on the NPPES file for the date of service billed.

Get alerts when payers change rules like this one

We check Medi-Cal and other payers every day and email you when a change matches your specialty and state.

Get Medi-Cal alertsPolicy Monitoring is free. No card required.

What to do

by Feb 1, 2027 · 7 steps
01Billing team must implement the following changes for all Medi-Cal covered LTC claims.
02Ensure billing software requires and validates both Attending and Referring provider NPIs on initial, discharge, and transfer claims submitted on the UB-04 claim form.
03Ensure Attending provider NPI is included on all ongoing claims.
04Verify that all submitted NPIs are valid Type 1 (Individual) NPIs registered on the National Plan and Provider Enumeration System (NPPES) file for the date of service billed.
05Update claim submission workflows to cross-reference NPPES file status before submission.
06Consequences of non-compliance: Claims will be denied if Attending or Referring provider NPIs are invalid, missing, inactive, not on the NPPES file, or are not Type 1 Individual NPIs.
07Contact Medi-Cal for updated provider manual sections when released.

Original notice

Ordering, Referring and Prescribing: NPI Requirements for LTC Providers
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Medi-Cal policiesCA policy changesGeriatrics

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account