Author Topic: Individual vs Group NPI's  (Read 5742 times)

wharta

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Individual vs Group NPI's
« on: December 17, 2010, 12:54:10 PM »
Quick question. I have a solo provider who would like to add other providers to her group. She will be receiving the payments and paying them. She has an individual npi which we also use as her billing npi for her group. Will she be able to continue to bill like this with the new rendering providers or do we need to file for a whole new group npi to keep it seperate?

medauthor

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Re: Individual vs Group NPI's
« Reply #1 on: December 20, 2010, 12:09:32 AM »
Have these new providers practiced elsewhere before?  Do they already have their own individual NPIs?  You say "Add to her group", but she does not have a GROUP NPI??
Michelle Rimmer, CHI, CPMB
President-Professional Medical Billers Association
Owner-ABA Therapy Billing Services
Author, 'Medical Billing 101' and 'Coding Basics: Understanding Medical Collections

wharta

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Re: Individual vs Group NPI's
« Reply #2 on: December 20, 2010, 07:00:49 AM »
The new providers have there own npis and they practice on their own. Her npi is her own but since she is a solo provider we use her npi and group name which is her last name inc.

Michele

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Re: Individual vs Group NPI's
« Reply #3 on: December 20, 2010, 07:18:32 AM »
If she is incorporated then she must be using an EIN right?  If so, she should have a group NPI for the corporation and EIN.  Then you need to notify all insurance carriers of the EIN & Group NPI.  Then you can have all new providers linked to the group EIN & NPI.

It's a little work up front, but better to have it all set up correctly.

Michele
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wharta

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Re: Individual vs Group NPI's
« Reply #4 on: December 21, 2010, 09:41:59 AM »
But we already have her set up with insurance using her ein, group name and personal npi. She can't just link them to her personal?

Michele

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Re: Individual vs Group NPI's
« Reply #5 on: December 22, 2010, 08:13:18 AM »
If she was a sole proprietor that is how it would be done, but if she's incorporated it should have been under a group NPI.  You can try contacting the insurance carriers and see if they will link that way.  The text book answer is that she should have a group NPI for the corporation.

I know, it's a pain when it's already set up.  Try contacting them and see what they say.

Michele
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