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03/28/2024 02:56 PM
Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20230&cosponId=39352
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House of Representatives
Session of 2023 - 2024 Regular Session

MEMORANDUM

Posted: January 17, 2023 11:25 AM
From: Representative Mike Cabell
To: All House members
Subject: Requiring Medicaid providers to use either National Provider Identification or State Provider Identification number
 
On March 1st, 2019, Attorney General Josh Shapiro released the findings of a grand jury about preventing fraud within our Medicaid program.  The grand jury made several recommendations including requiring anyone providing services under Medicaid in the commonwealth have either a National Provider Identification (NPI) or receive a State Provider Identification number (SPI).   In addition to this recommendation, the grand jury also recommended legislation strengthening the requirements for Medicaid providers for documenting services provided by the Medicaid provider.  

This legislation would require any provider which seeks to operate in the Medicaid program use either an NPI or register for SPI.  The Department of Human Services would be required to establish a standardized program for any company which lacks an NPI and must register for provider identification with the state.  This training would teach providers how to submit claims for reimbursement from Medicaid by using their provider number along with the date, time and service provided. The legislation also includes a clarification of current law recommended by the Attorney General’s office which clarifies current law on where civil claims for Medicaid fraud can be filed.
 



Introduced as HB876