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Following the passage of SB 5950, Sec. 211 (34), the Health Care Authority (HCA) is implementing a birth doula benefit for Apple Health (Medicaid) clients with an anticipated effective date in early 2025.
Birth doulas must have a National Provider Identifier (NPI) to enroll as a provider in Apple Health (Medicaid) and to bill HCA for doula services.
What is an NPI?
An NPI is a 10-digit, unique identification number issued to a health care provider. It is assigned by the National Plan and Provider Enumeration System (NPPES).
There is no cost to apply for an NPI. The NPI is meant to be a lasting identifier for the provider. This means the NPI remains the same, even if the provider changes their name, address, or other information.
Visit CMS Unique Identifiers FAQs for more information about NPIs.
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How do I apply for an NPI?
There are two application options:
- Online at the NPPES website.
- Paper application from NPPES. To request a paper application, contact call 800-465-3203 or TTY 800-692-2326, or send an email to [email protected].
How long will it take to get my NPI after I submit my application to NPPES?
A provider who submits a properly completed online application can receive an NPI in fewer than 10 business days. Paper application reviews take approximately 20 business days. Application errors may delay the process.
I am a birth doula and have my NPI. Does this mean I can start seeing Apple Health clients and billing for those services?
No. Obtaining an NPI is only one of several steps toward becoming an Apple Health provider. A future bulletin will notify birth doulas when Apple Health provider enrollment is open.
The plan is to allow birth doulas to enroll as Apple Health providers prior to benefit implementation in early 2025. Enrolling in advance of the benefit start date is strongly encouraged to prevent delays in provider reimbursement.
Sign up for doula bulletins from HCA to stay updated and share this bulletin with other doulas, doula partners, and interested stakeholders.
What information is needed to complete the NPI application?
The NPI application requires the following information:
- Personal identifiers such as full name, date of birth, address, phone number, and e-mail address.
- Provider taxonomy code.
- Department of Health birth doula certificate number.
What is a provider taxonomy code?
A taxonomy code identifies the provider’s specialty. The taxonomy code is self-selected and self-reported by the provider. Taxonomy codes are used when submitting claims for reimbursement.
The birth doula taxonomy is 374J00000X.
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