Author Topic: 2 Group NPIs  (Read 2169 times)

jlgorske

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2 Group NPIs
« on: November 19, 2008, 09:07:16 PM »
I would love any help you can provide with this scenario.  I bill for a Nurse Practitioner that owns her own family practice.  She is credentialed with all insurances under her own tax-id.  We have been billing under her own tax-id for 9 months now.  Because of the way she was credentialed with Blue Cross Blue Shield, they required her to get a group NPI and she must file under that.  If we file under her individual NPI, we get rejections stating that is not a billing NPI. 

Now, we have a new collaborating physician who also has her own practice at a different location.  She comes to our clinic a couple days a week as required by law.  She too is credentialed with BCBS under her group NPI. 

So now, here's where our issues begin.  Because our NP cannot be a PCP on HMO plans, those claims must be filed under the MD using an SA modifier showing the NP acutally saw the patient.  Because we must file BCBS claims using group NPIs, we have the clinic's name and address with it's group NPI in 32 and 32a.  We then have the clinic's name and address and the MD's group NPI in 33 and 33a.  We then have the MD's individual NPI in 24j.  Basically the only thing on the claim that designates the NP was involved is the SA modifier and her clinic's group NPI in 32a.  Can you have 2 different group NPIs on the same claim?  How should we be billing this scenario?

Also, we want all of the payments to come to our clinic where the service was performed, NOT the doctor's other location.  Even though we put that information in 32 and 33, checks and EOBs are going to the doctor's main office.  How are insurance companies getting that address?  Does the doctor need to add our clinic's address to each indivdual insurance carrier? 

Thanks in advance for any help you can give!

Julie

Michele

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Re: 2 Group NPIs
« Reply #1 on: November 20, 2008, 06:29:31 AM »
Hi Julie,
   The group name & NPI that should be in box 33 is the one that payment is going to.  So you want the NP's group name & group NPI in box 33, you want the MD's individual NPI in 24J, but you don't want the MD's group NPI anywhere on the claim.  The only catch to this scenario is that you must make sure BC has the MD's individual NPI linked to the NP's group name & NPI.  (NP's group name & NPI also go in box 32 since that is where the services where performed.)

Whewwwwww.  I hope that makes it clear.  :)

Michele
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jlgorske

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Re: 2 Group NPIs
« Reply #2 on: November 20, 2008, 09:14:42 PM »
Thank you for such a quick response.  I'm still a little confused though.  Our MD is credentialed with BCBS only with her group NPI
(when I filed using her individual NPI, it rejecting b/c that NPI was not valid for billing).  Also, our NP is credentialed with BCBS only with her group NPI.  What NPI box does the insurance company use to process the claim and decide how to pay out???  If it's 24j, then I cannot put the MDs individual NPI in 24j because it's not valid for billing. 

Sorry if this isn't making sense.  I am so confused right now......

Michele

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Re: 2 Group NPIs
« Reply #3 on: November 21, 2008, 03:54:15 PM »
When they say you are 'credentialed under the group NPI' and that the individual NPI is 'not valid for billing' they don't mean that you can't use it in 24j.  The billing NPI goes in 33a, and if you are credentialed under a group NPI then you must have that NPI in box 33a.  But the actual individual NPI of the rendering provider must be in 24J.  24J has to be an individual NPI, it cannot be a group NPI.  Since the scenario you described has to be billed as the MD rendering the service but with the modifier indicating the NP, you would need to use the MD's individual NPI in 24J.  But since it is the NP and her practice you need to use the NP's group NPI in the billing field 33a.  But the MD's individual NPI must be linked to the NP's group NPI.  She can also have her individual NPI linked to her own group NPI as well.  A provider can have 1 individual NPI linked to more than one group NPI.

If the claims are denied and you have done it as I've described then you need to contact BC because they have something incorrect at their end.

Good luck and I hope the answer isn't too confusing.  :)

Michele

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