Reminder: NPI Requirement for Service Facility Location on Claims

Date: May 30, 2025

Attention: Providers

Call to action: This communication serves as a reminder of the National Provider Identifier (NPI) requirement for the service facility location, as outlined in the Texas Medicaid Provider Procedures Manual (TMPPM),Section 6: Claims Filing, TMPPM, 6.4Claims Filing Instructions.

Per the TMPPM:

“Facility Provider field blank or invalid. When place of service (POS) is anywhere other than home or office, the facility’s NPI must be present. If the NPI is not known, enter the name and address of the facility. Consult the software vendor for this field’s location on the electronic claims entry form.”

How this impacts providers: Claims submitted without the service facility NPI number in loop 2310C (CMS-1500) or loop 2310E (UB-04) will be rejected at the clearinghouse level.

Next step for Providers: Providers must ensure compliance with this NPI requirement. Please work with your clearinghouse or billing software vendor to confirm that the NPI is correctly captured and submitted.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.