10 Colo. Code Regs. § 2505-10-8.126.3
Current through Register Vol. 47, No. 11, June 10, 2024
Section 10 CCR 2505-10-8.126.3 - Health Care Provider Requirements to Obtain and Use an NPIA. A Health Care Provider that is required or eligible to obtain an NPI pursuant to 45 C.F.R. § 162.410 must: 1. Enroll with a unique NPI that identifies the Health Care Provider that delivers medical care, services, or goods authorized under the Medical Assistance Program; and2. Utilize the Health Care Provider's unique NPI for all Claims.a. A Health Care Provider that is not enrolled as of January 1, 2020, must submit every Claim using the unique NPI used for enrollment that identifies both the Provider Type and Site effective for date-of-services on or after January 1, 2020.b. All Off Campus Locations must submit every Claim using the unique NPI used for enrollment that identifies both the Provider Type and Site effective for date-of-services on or after January 1, 2020.c. All Health Care Providers must submit every Claim using the unique NPI used for enrollment that identifies both the Provider Type and Site effective for date-of-services on or after January 1, 2021.d. On every Claim, including Coordination of Benefits Agreement (COBA) automatic crossover Claims, the Organization Health Care Provider shall use the Service Facility Location Field to represent the most specific Site with an NPI where the services are rendered unless the Billing Provider Field represents the most specific Site with an NPI where the services are rendered.42 CR 21, November 10, 2019, effective 11/30/201946 CR 01, January 10, 2023, effective 1/1/202346 CR 07, April 10, 2023, effective 4/30/2023