License Number for emedny - How to send a License Number as a Provider Identifier?

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1 License Number for - How to send a License Number as a Provider Identifier? This requirement applies to trading partners sending the ASC X12N 270, 278, and 837 transactions, and NCPDP 5.1 Telecommunications and 1.1 Batch requests. Although using a License Number to identify a provider is supported, it is strongly recommended to use the NPI as the identifier for all providers who are eligible to receive an NPI, and a NYS Medicaid Provider ID to identify Atypical Providers. All NPIs can be looked up at the NPPES at the following URL: When using a License Number as a provider identifier for, NYSDOH requires a three-digit as a prefix. The codes are a subset of the two-digit s assigned by the New York State Department of Education Office of the Professions (NYSED/OP) when it issues professional licenses. A leading zero is added to the left to create the NYSDOH three-digit and, for NYS licensed providers, two more zeros must follow between the and the License Number. Exceptions exist for: using a license number to identify a NYS licensed Privileged Nurse Practitioner or Privileged Midwife. In these two cases a value of 0F must be inserted between the and License Number instead of the two zeros. using a license number to identify a NYS licensed Optometrist or other eye-care practitioner with prescribing privileges. A value of 0V, 0T, or 0U - depending on the value on the NYS license - must be inserted between the and License Number instead of the two zeros. This is not applicable to Ophthalmologists. All out of state licenses must be formatted with the two-letter State, District of Columbia, or US Territory Code as assigned by the United States Postal Service instead of the 00, 0F, 0V, 0T, or 0U values. This formatting specification will allow the association of the provider on a claim with a provider reported on an X Prior Authorization in the Requester Supplemental Identification and/or Service Provider Supplemental Identification segment(s) using the ZH qualifier. When reporting the Prescriber ID in the NCPDP Prescriber Segment (a Qualifier of 08 is used), NYSDOH expects Provider and NYS Provider License Number. If an out of state License Number is used, 1

2 NYS expects the NYS Provider for out of state practitioners, a USPS State Code and the Provider License Number. NYSED/OP also issues temporary limited permits for Physician s Assistants and Physicians who are not yet licensed. The limited permit numbers begin with a P followed by five digits. These permit numbers cannot be sent in electronic claims transactions. A supervising physician s license or Provider ID must be sent instead, if the permit holder would otherwise be identified as the Rendering or Attending Provider. Table The system requires a three-digit as a prefix to the License Number for processing claims and other electronic healthcare transactions in which the license has been used to identify a provider. The is printed on the NYS license. Both the and License Number for all NYS licensed professionals are available from the NYS Department of Education, Office of the Professions at the following URL: The following table shows how to send the and License Number for NYS Medicaid electronic healthcare transactions such as healthcare claims. Using dummy values to represent the License Number, compound identifiers are created as examples (for out of state license examples, the District of Columbia abbreviation of DC is shown). NYS Dept. of Education Description MENTAL CREATIVE ARTS THERAPY MENTAL MARRIAGE AND FAMILY THERAPY PRACTICAL NURSE MENTAL COUNSELOR PSYCHOANALYST REGISTERED NURSE PHARMACIST

3 NYS Dept. of Education Description 021 PHARMACIST LIMITED 3-YEAR LICENSE PHYSICIANS ASSISTANT SPECIALIST ASSISTANT ACUPUNCTURE MASSAGE THERAPY MIDWIFERY MIDWIFERY WITH PRESCRIBING PRIVILEGE 0280F DIETETICS/NUTRITION CERTIFIED DENTAL ASSISTANT DENTIST DENTIST HYGIENTIST RESPIRATORY THERAPIST RESPIRATORY THERAPY TECHNICIAN OPTHALMIC DISPENSER OPTHALMIC DISPENSER WITH PRESCRIBING PRIVILEGE 0550V or U OPTOMETRIST OPTOMETRIST WITH PRESCRIBING PRIVILEGE 0560V or U or T AUDIOLOGY SPEECH THERAPY DENTAL SCHOOL PHYSICIAN - MEDICINE & OSTEOPATHY MEDICINE LIMITED PRACTICE PHYSICAL THERAPIST OCCUPATIONAL THERAPIST OCCUPATIONAL THERAPIST ASSISTANT PODIATRIST PHYSICAL THERAPIST ASSISTANT ATHLETIC TRAINER

4 NYS Dept. of Education Description 068 PSYCHOLOGIST CHIROPRACTOR/PORT XRAY SVC(QMB) LICENSED MASTER SOCIAL WORKER LICENSED CLINICAL SOCIAL WORKER DENTAL PARENTERAL CONSCIOUS SEDATION DENTAL GENERAL ANESTHESIA DENTAL ENTERAL CONSCIOUS DENTAL PARENTERAL CONSCIOUS SEDATION DENTAL ANESTHESIA

5 Description for Out of State licenses OUT OF STATE MENTAL CREATIVE ARTS THERAPY OUT OF STATE MENTAL MARRIAGE AND FAMILY THERAPY 5 (All out of state examples show a license from the District of Columbia) 005 DC DC OUT OF STATE PRACTICAL NURSE 010DC OUT OF STATE MENTAL COUNSELOR 018 DC OUT OF STATE PSYCHOANALYST 019 DC OUT OF STATE REGISTERED NURSE 022DC OUT OF STATE PHARMACIST 020DC OUT OF STATE PHYSICIANS ASSISTANT 023DC OUT OF STATE SPECIALIST ASSISTANT 024DC OUT OF STATE ACUPUNCTURE 025DC OUT OF STATE MASSAGE THERAPY 027DC OUT OF STATE MIDWIFERY 028DC OUT OF STATE DIETETICS/NUTRITION 048DC OUT OF STATE CERTIFIED DENTAL ASSISTANT 049DC OUT OF STATE DENTIST 050DC OUT OF STATE DENTIST HYGIENTIST 051DC OUT OF STATE RESPIRATORY THERAPIST OUT OF STATE RESPIRATORY THERAPY TECHNICIAN 052DC DC OUT OF STATE OPTHALMIC DISPENSER 055DC OUT OF STATE OPTOMETRIST 056DC OUT OF STATE AUDIOLOGY 057DC OUT OF STATE SPEECH THERAPY 058DC OUT OF STATE DENTAL SCHOOL 059DC OUT OF STATE PHYSICIAN - MEDICINE & OSTEOPATHY 060DC OUT OF STATE PHYSICAL THERAPIST 062DC OUT OF STATE OCCUPATIONAL THERAPIST OUT OF STATE OCCUPATIONAL THERAPIST ASSISTANT 063DC DC OUT OF STATE PODIATRIST 065DC OUT OF STATE PHYSICAL THERAPIST ASSISTANT 066DC123456

6 Description for Out of State licenses (All out of state examples show a license from the District of Columbia) 067 OUT OF STATE ATHLETIC TRAINER 067 DC OUT OF STATE PSYCHOLOGIST 068DC OUT OF STATE CHIROPRACTOR/PORT XRAY SVC(QMB) OUT OF STATE LICENSED CLINICAL SOCIAL WORKER OUT OF STATE DENTAL PARENTERAL CONSCIOUS SEDATION OUT OF STATE DENTAL GENERAL ANESTHESIA OUT OF STATE DENTAL ENTERAL CONSCIOUS OUT OF STATE DENTAL PARENTERAL CONSCIOUS SEDATION 070DC DC DC DC DC DC OUT OF STATE DENTAL ANESTHESIA 089DC

7 License Number as Identifier for Nurse Practitioners Licenses for NYS Nurse Practitioners include the as the first two digits of the License Number. There are seventeen NYS-licensed areas of Nurse Practitioner specialization. The specification does not change for these providers, other than the requirement to insert a value of 0F between the and License Number for services rendered by a Privileged Nurse Practitioner (those with prescribing privilege). NYSDOH Description ADULT ADULT COLLEGE COLLEGE COMMUNITY COMMUNITY FAMILY FAMILY GERONTOLOGY GERONTOLOGY NEONATOLOGY NEONATOLOGY OBSTETRICS & GYNECOLOGY F F F F F F

8 NYSDOH Description 036 OBSTETRICS & GYNECOLOGY 0360F ONCOLOGY ONCOLOGY 0370F PEDIATRICS PEDIATRICS PERINATOLOGY PERINATOLOGY PSYCHIATRY PSYCHIATRY SCHOOL SCHOOL WOMEN S WOMEN S ACUTE ACUTE PALLIATIVE PALLIATIVE HOLISTIC 0380F F F F F F F

9 NYSDOH Description HOLISTIC ANESTHESIA ANESTHESIA 0450F F Modified: October 25,