Issues Affecting Community Alternative Program (CAP) Claims

Effective July 3, 2025, the federal requirement for ordering and referring National Provider Identifier (NPI) on Community Alternatives Program (CAP) claims for home and community-based services is paused. Claims without those NPIs will no longer deny. This pause is a temporary relief measure for all service dates to allow impacted providers time to work with their billing agents to meet this requirement.

A reprocessing will occur for impacted claims that were denied.

Additional announcements will be posted with more details about the reprocessing date and when the pause will be removed which will result in denials when the ordering and referring NPI is not on the claim.

Please refer to the June 20 announcement for links to additional helpful guides.