Author Topic: Group billing NPI number  (Read 1800 times)

spamelita

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Group billing NPI number
« on: August 01, 2013, 07:08:46 PM »
We have a group practice with eight providers. We have a group NPI for billing professional claims. What I'm wondering is since we have this Group NPI, do we need to contact the insurance companies to let them know which providers are covered under this NPI?  How are the individual providers connected to the group NPI?

RichardP

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Re: Group billing NPI number
« Reply #1 on: August 02, 2013, 02:51:04 AM »
Your Group was no doubt established with the aid of a health-care attorney or some other person who is knowledgable about health-care laws for your state.  They would be the one(s) to submit your question to.

After your Group was established as a legal entity, it should have then been established as the billing entity - by the Group contracting with specific insurance carriers.  As the billing entity, the Group should have given each insurance carrier it contracted with its Type 2 (who gets paid) NPI Number.  And the Group should have given each individual carrier a list of the providers who were owners and/or employees of the Group, along with their Type 1 (who is doing the work) NPI Numbers.  I can't imagine that any given insurance carrier would consider the contracting process concluded without the carrier receiving these numbers.

The billing entity's (the Group's) Type 2 NPI Number goes in Box 33a of the CMS 1500 Form.  The individual provider who actually did the work would have their Type 1 NPI Number go in Box 24J of that Form - but only if the insurance carrier required it (Medicare does, but many other do not).