Author Topic: help with individual provider treating in group practic  (Read 780 times)

KARREN

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help with individual provider treating in group practic
« on: March 31, 2010, 05:23:05 PM »
Insurance= UHC Dr A in network & Clinic (group) not in network
Dr A works at 2 location.. Clinic is the 2nd location..  Dr A sees the pt at the clinic..  what's the correct way to bill?
Senario 1=  Dr A individual NPI goes in 24J, Dr A tax id# goes in 25, Clinic faciliy location goes in 32 and clinic group npi goes in 32a,
clinic billing address which is the same as clinic facility location goes in 33a and clinic group npi goes in 33a.   OR
Senario 2= Dr A individual NPI goes in 24J, Dr A tax id# goes in 25, Clinic facility info goes in 32, group npi goes in 32a, and Dr A billing info goes in 33 and Dr A individual NPI goes is 33a.   I'm still a little confused.. thanking you in advance for your help.  I truly appreciate it. 

Michele

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Re: help with individual provider treating in group practic
« Reply #1 on: April 01, 2010, 09:42:21 AM »
If the Dr wants to bill the claim out and have it processed in network, then all of his/her info goes on claim, his/her NPI in 24J and 33A, his/her EIN in 25, His/her billing info in 33, and the clinic address & NPI  in 32.  The EIN in 25 must match the billing info in box 33.  But the payment will go to the physician, not the clinic.  If he is employed by the clinic and the billing is supposed to go out under the clinic, then his/her Individual NPI goes in 24J and the clinics EIN goes in 25, the clinics info & NPI go in 32 & 33.

Michele
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