Medicare Rejection Urgent

[Anand]

REJECTED AT CLEARINGHOUSE BILLING AND RENDERING PROVIDER NPI CANNOT BE THE SAME VALUE (MR002)

Can someone please help?

[shanbull]

I'm thinking they want a type 2 NPI (organization NPI) in the billing provider field? Is this for a solo practitioner?

[RichardP]

What shanbull said.

On the CMS 1500 Form (or electronic equivalent):

- Box 33a must contain Type 2 NPI Number (who gets paid);

- Box 24j must contain Type 1 NPI Number (who did the work).

Those two numbers must be different.

[dekenn]

Those two numbers are not different, however, if it is a sole practitioner. They are the same number.

[RichardP]

Those two numbers are not different, however, if it is a sole practitioner. They are the same number.

I can see where this might be true when a sole practitioner has no employees.  In such a situation, the provider has no need to obtain an Employer ID Number (EIN).  But my understanding is that, if the sole proprietor has obtained and EIN, he must obtain a Type 2 NPI Number connected to that EIN.

Can you clarify under what other conditions your quote might be continue to be true?  Or a link to a discussion that provides such information?  You've piqued my curiousity.

[Christy]

In New York, a sole proprietor can have an EIN with just an individual NPI. The first place to call is the clearinghouse, they are usually pretty helpful.

This  happened to me once, and after much research, it was determined that when the provider signed herself up with Medicare, she checked off the box: "are you enrolling solely to refer services...."   Once that was changed to provide services, it was all fixed....

But definitely, start by calling the clearinghouse, hopefully it's just a glitch and not a provider enrollment problem....

[dekenn]

Richard, I don't have a link to reference. All I have is my experience. We are a sole proprietor, not incorporated or LLC, just sole proprietor Yes, we do have an EIN. No, we do not need a Type II NPI. All of this was clarified with Medicare when we were required to get NPI's. I bill with the same NPI for both rendering and billing. Haven't had a problem. I think the key is "sole proprietor". Some physicians are sole "practitioners" but have created an LLC or some other "organization".

[RichardP]

Thanks for the elaboration.  When the NPI numbers started, we had a sole propriertor who obtained the Type 1 and 2 NPI Numbers - because he employs staff and has an EIN.  Our billing was rejected.  Medicare wanted only the Type 1.  So we billed that way for a while and then suddenly the billing was rejected again.  They wanted both Type 1 and Type 2.  We went back to that and have been OK ever since.  The provider did not change his status during this time.  I attribute the whole thing to Medicare getting its act together in-house.  He is sole proprietor, but incorporated.

[dekenn]

Hi Richard. The key is being incorporated. That would require a Type II NPI number. We do have employees, and an EIN number, but no incorporation, just "sole proprietorship".