Medical Billing Forum

NPI Numbers => NPI Numbers => Topic started by: ste on December 13, 2009, 07:44:39 PM

Title: NPI Registry Info
Post by: ste on December 13, 2009, 07:44:39 PM
A young physician incorrectly has his home address listed as his Business Practice Location in the NPI Registry for whatever reason (probably he started out with a home office, then opened his current new office and hasnít put a change of address in with NPPES, even though he has been there much longer than 30 days). If he enters his new office location on line 33 (CMS-1500) and his NPI# on line 33a do carriers ever cross reference NPI Registry info (ie the Provider Business Practice Location) for a specific NPI#  with the location address reported on line 33? Could this be a likely source of denied claims? 

Title: Re: NPI Registry Info
Post by: Michele on December 13, 2009, 08:03:04 PM
I have not heard of carriers verifying address info via the NPI system.  Many drs have more than one practice location, or even work for multiple clinics.  NPI doesn't allow for this so I wouldn't think they could use the NPI for that.

Title: Re: NPI Registry Info
Post by: jcbilling on December 14, 2009, 09:15:00 PM
I would have said the same thing, until last week.

We have a insurancie carrier that is denying some physical therapy claims based on the Primary Taxonomy code listed on the provider's NPI record in the database. So it depends on the carrier and if they reference the NPI record for the provider.

In your situation, I'm not sure they would deny the claim because of a different address though. We bill for a group that has 3 different locations and only one of the locations is listed on the NPI record, but it's not the same address on the cliam form. The only issue I see happening is that the provider might have checks coming to his home address if in fact the carrier uses the NPI database has a cross reference.