NOTE: This information will be updated with the implementation of the new provider enrollment system, which is scheduled for April 2026. To stay informed about the transition effort, sign up for Florida Medicaid Health Care Alerts.
Federal legislation known as the Patient Protection and Affordable Care Act, Section 6402, signed into law on March 23, 2010, requires that all claims submitted to Medicare and Medicaid contain the provider’s National Provider Identifier (NPI). Florida Medicaid requires all providers and health plans who must obtain an NPI to include their NPI on all claims submitted to Florida Medicaid.
NPI Initiative
The Agency for Health Care Administration (Agency) has implemented the NPI Initiative, to enhance NPI related self-service tools and documents. These enhancements will assist providers and health plans who have multiple Medicaid Provider IDs sharing a single NPI to identify the NPI information to include on an X12 837 transaction and facilitate the mapping of their submission to the appropriate provider file.
Provider Enrollment:
Providers will need to have the following NPI information associated with their Medicaid account when enrolling with Florida Medicaid:
- Individual Providers (NPI Type 1) - will report additional office locations as ‘affiliates’ on one (1) provider record. Separate provider records will no longer be allowed unless the provider performs a different type of service at the additional location. If providing a different type of service, the provider may enroll the additional location by submitting a Florida Medicaid Enrollment Application for the provider type.
- Organizational/Group Providers and Medicaid Health Plans (NPI Type 2) - The following organizational entity types WILL NOT be required to apply unique NPIs to their current and future Medicaid Provider ID’s new location codes.
| Nurse Practitioner Group | Home Health Services (Unlicensed Personal Care Groups Only) | Physician Assistant Group |
| Therapist Group | Dental Group | Physician, M.D. or D.O. Group |
| Audiologist or Hearing Aid Specialist Group | Federally Qualified Health Center | Podiatry Group |
| Chiropractor Group | Specialized Therapeutic Services Group | Rural Health Clinic |
| Pharmacy/DME | Home and Community-Based Services | Community Behavioral Health Services |
| Optician or Optometry Group |
- Organizational (Entity Type 2) providers that are not listed in the entity type groups defined above will be required to have a unique NPI for each service location.
Note: Provider’s entity type in the National Plan and Provider Enumeration System (NPPES) must match the Provider Entity Type on the provider’s Medicaid record.
Claims/Encounter Processing:
- The NPI submitted on an 837 X12 transaction is used to identify a provider’s Medicaid ID. Submitted X12 837 data is utilized to acquire the Medicaid Provider ID and associated service location. If the submitted NPI alone is sufficient to acquire the Medicaid Provider ID, meaning there is only one (1) Medicaid Provider ID associated with the submitted NPI; a taxonomy would not be required to make that determination and would not post a denial edit for that reason.
How to Verify Existing NPI Information
The following are two ways in which actively enrolled providers can verify NPI information that is currently registered to a Medicaid provider file:
- Provider Information panel on the Secure Web Portal (Secure Web Portal > Demographic Maintenance > NPI);
- NPI to Medicaid ID Search Engine on the Provider Information panel of the Secure Web Portal (Secure Web Portal > Demographic Maintenance > Quick Links > NPI to MCD Search)
Secure Web Portal NPI Panel
1. Providers will need to log into the Secure Web Portal using their Medicaid Provider ID.
2. Once logged in, click Demographic Maintenance.
3. Then click, the NPI link at the top of the Provider Information window. This will direct users to the NPI panel.
NPI to Medicaid ID Search Engine
To view active NPI data in FMMIS, select NPI to Medicaid ID Search Engines under Quick Links on the Secure Web Portal.
Once the user clicks the NPI to Medicaid ID Search Engine link, the panel below will display.
How to Update an NPI
1. NPI Self Service Tool – Below the provider’s NPI Panel, there is a panel titled “NPI” which will allow a provider to update their NPI information.
2. If modifying a NPI crosswalk used to bill claims with date of service prior to 03/01/2022, the NPI registration form should be submitted.
How to Complete Electronic Claims Batch Upload Using NPI
Electronic batch claims must include the NPI (National Provider Identifier) for every provider to match them to their Medicaid ID.
When submitting a billing provider’s NPI with a taxonomy code and Zip+4, ensure the taxonomy reflects the provider’s specialty and the Zip+4 matches their address. The rendering provider may also include a taxonomy. If a ZIP code is required for the rendering provider, use the full 9‑digit ZIP in the service facility section. Do not repeat rendering provider details if they are the same as the billing provider.
For detailed information, refer to the Electronic Data Interchange (EDI) Companion Guides. The NPI requirement is not applicable to Web Portal Direct Data Entry (DDE) claims.
Electronic Medicare Crossovers
Medicare uses NPI as the primary identifier and follows the X12/837P rule that if a rendering provider is present (2310B), the billing provider’s taxonomy code (2010AA) must not be sent. Because Medicare strictly applies this rule, any taxonomy submitted in the 2000A loop will not be forwarded to Medicaid on crossover claims. As a result, some auto‑crossover claims may reach Florida Medicaid without the taxonomy information required for proper NPI‑to‑Medicaid ID matching. Refer to the 837P Companion Guide for additional information.
If a taxonomy code is needed to uniquely map a provider’s Medicaid ID and NPI, the crossover claim may deny.
If a fee‑for‑service crossover claim denies for missing taxonomy, providers may log into the secure Web Portal, locate the denied claim, and resubmit it. Providers may also send the secondary claim directly to Medicaid electronically to ensure the taxonomy is included.
Who Can Bill Claims Without an NPI?
Certain provider types are exempt from the requirement of using an NPI to bill claims to Florida Medicaid. These are known as ‘atypical providers.’ Below is a list of Provider Types that are exempt from billing using an NPI. Instead, these provider types can bill claims using their Florida Medicaid Provider ID.
| Provider Type | Provider Description |
| 14 | Assistive Care Services |
| 23 | Medical Foster Care/Personal Care Provider |
| 32 | Social Worker/Case Manager (Excludes specialty 177-CMS/MFC TCM) |
| 33 | Approval Agency |
| 41 | Non-Emergency Transport |
| 43 | Taxicab Company |
| 44 | Government/Municipal Transport |
| 45 | Private Transportation |
| 46 | Non-Profit Transportation |
| 47 | Multi-Load Private Transport |
| 67 | Home and Community Based Services Waiver |
| 70 | Medicaid Health Plan |
| 72 | Prepaid Mental Health Services |
| 75 | Vocational Rehabilitation Agency |
| 76 | Developmental Disability Agency |
| 78 | Children's Medical Services |
| 79 | Bureau of Blind Services |
| 80 | Aging & Adult Services |
| 82 | Paraprofessional Early Intervention Services |
| 86 | Non-Provider Mail List Only |
| 91 | Case Management Agency |
| 98 | Lien Holder |
| 99 | Trading Partner |
NPI is not required for provider type (PT) 65 Home Health Services (Only specialty 114 – Personal Care). NPI is not required for PT 84 School Health Provider (Specialties 816 – School Counselor; 818 – School Health Aide; 819 – School Psychologist; 820 – Social Worker).
Web Portal Administrator Change Request Reminders
Providers and Administrators seeking to reset their PIN, password, or update the Administrator for their Secure Web Portal account, visit Help with PINs and Passwords.
Additional Resources
Florida Medicaid Contact Information Sheet
Support
Training
AHCA Adopted Rules
AHCA Medicaid Forms
Provider Enrollment Policy incorporated by reference in Rule 59G-1.060, F.A.C.
TIP: Download Adobe Acrobat Reader to open or save PDF documents.