Help please

[cfobilling]

Ok so, I have a doctor that was with a group practice billing under the group tax ID and his individual NPI.  He has left that practice and started his own practice as of dec 1st.  We obrained a new tax ID for his new practice name and notified all insurance carriers of the changes along with w-9.  His billing address and service location have not changed they are remaining the same.  The only thing that changed was his tax id and the name of the group.

We are billing with the new tax ID and his individual NPI.  Things went smooth with most insurance carriers, but a few are giving us problems with paying out of network, they are showing the doctor as innetwork but the group as non par.  Or not linking the doctor with the group.  One insurance carrier told us that we would need to get a type 2 NPI for the group (even though he is the only doctor in his group).  We went ahead and obtained a type 2 npi for the group.  My question now is should he no longer bill any insurance carrier with his individual NPI?  How should we bill?  It was only this one carrier who requested a type 2.  Must we notify all insurance carriers of his type 2 npi? 

What would be the best way to resolve this. 

Thank you so much for your help in advance

[Michele]

You are definitely supposed to have a type II NPI for the group name and EIN/Tax ID number (even if it is only 1 dr in the group).  The individual NPI is linked to his ss# and I wouldn't be surprised if the insurance carriers are paying under the ss instead of the Tax ID.  The right thing to do is to get the group NPI on file with all insurance carriers with the Group Name & Tax ID.  That is the only way to ensure that the tax liability will be correct.  Also, consistency in billing is crucial to keep things running smoothly.  If you are billing one company one way and other companies differently, it can get messy.

Michele

[cfobilling]

Thank you, we do have the group NPI but werent sure if we should use it.  I started billing for him when he was part of his last practice and they used individual NPIs but still were paid under the group name so it got confusing.  This new group NPI, would it be enough to place the NPI on this bills or should I also send out a letter to each insurance carrier to notifiy them of the changes? 

[Michele]

You should check with each carrier to make sure they have the group NPI on file for your group.

Michele

[dfranklin]

I ran into a similar issue. I worked with the provider and all the carriers to make sure it was set up the same and to make sure it was under his Group NPI and EIN.  A little work up front but now everything is going smoothly and the doctor will not have any tax issues down the road.