Maryland Medicaid Now Requires a Separate NPI for Every Practice Location

To enhance provider enrollment efficiency and minimize claim denials, Maryland Medicaid is introducing a policy mandating unique National Provider Identifier (NPI) numbers for each practice location. This change complies with Centers for Medicare & Medicaid Services (CMS) standards and aims to synchronize our billing and enrollment systems. Full details are available in Section 7 of the 2024 Winter General Provider Updates.
Steps to Take

Secure a unique NPI for each practice location. Affected providers will receive a notification specifying when to update their Maryland Medicaid Provider accounts. Do not modify existing accounts until notified. To obtain additional NPI numbers, use the National Plan and Provider Enumeration System (NPPES) or contact 800-465-3203 or 800-692-2326 (NPI TTY).

No ePREP applications are required for updates. Once the Maryland Department of Health (MDH) receives your new NPI spreadsheet, it will update the billing and enrollment systems on your behalf. You’ll receive an email confirmation from mdh.npiuncollapsing@maryland.gov upon completion.

After receiving state registration confirmation, use the new NPI(s) as your service facility NPI on claims. Ensure your billing NPI and location address, including the ZIP code+4, align with the active record in the state’s ePREP system.

Purpose of the Change

Currently, some practices in ePREP lack unique NPIs for multiple locations, hindering location-specific service tracking. Mismatched ZIP codes between practice addresses and state records also frequently lead to claim denials.

Exemptions

This policy does not apply to hospitals, which may continue using a single NPI across enrollments, or to providers with a Type 1 Individual NPI.

Need Assistance?

Visit Maryland Medicaid FAQs or access 24/7 support via chat in the UnitedHealthcare Provider Portal.