California Medicaid

Medicaid Provider ID and NPI Crosswalk

Per HIPAA 5010 X12 standards, Medicaid is not allowed to receive a Medicaid provider ID on electronic claims, if the provider has an NPI.

Medicaid may tell you the wrong provider ID was sent on a claim, but this means their crosswalk did not match the correct provider ID.

The payer is using a table of information that tells them which provider ID to assign to the claim after it has been received.

This table or "crosswalk" of information normally includes:

- Provider NPI

- Provider Address

- Provider taxonomy code

Common Medi-Cal Rejection Codes

California Medicaid, known as Medi-Cal, operates under unique protocols that can present challenges for providers. Understanding these intricacies is essential to ensure successful claims processing and avoid unnecessary rejections. Below, we outline key instructions and frequent challenges faced by providers.

For a list of common codes and their descriptions, refer to the following link: Common Codes and Descriptions PDF.

Rejection code: "Duplicate control record for same provider/claim type".

Reason: Medi-Cal's system may reject claims submitted individually on the same day if they have the same dollar amount. This is because Medi-Cal’s scrubbing system flags duplicate claims based solely on the dollar amount and does not validate other details, such as the patient’s name or service date.

Resolution: Follow these best practices:

1. Batch claims together: Submitting claims in batches minimizes the risk of duplicate rejections.
2. Avoid sending individual claims with the same dollar amount on the same day: If individual claims with identical amounts need to be submitted, wait 24 hours between submissions.
3. Make adjustments for resubmissions: Ensure claims flagged as duplicates are modified appropriately before resubmitting to avoid repeated rejections.