Frequently Asked Questions

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Does medical necessity need to be signed by a provider with an NPI and a MMIS number? If one number was included but not the other, is that medical necessity form no longer valid?

No, medical necessity can be signed by any LPHA listed in the Children and Family Treatment and Support Services (CFTSS) Provider Manual as long as it is within their scope of practice. If the LPHA does not have an NPI and/or MMIS number, that practitioner may use the NPI and/or MMIS number of their employing agency. There are some LPHAs who can make recommendations/determine medical necessity who may not be eligible to enroll in Medicaid as an individual practitioner. Therefore, those practitioners may not need to obtain an NPI. In these cases, the NPI number of the agency can be used in the Referring Provider field of the claim form.

Source: State January Roundtable 2019