Author Topic: Tax Id  (Read 1955 times)


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Tax Id
« on: April 24, 2014, 05:21:09 PM »
I just signed a new client but I am only doing the patology billing well they already have a Grp NPI and an Indv NPI but going to use a diffrent tax Id number will they have to notify ins company with the new tax id so claims will get paid


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Re: Tax Id
« Reply #1 on: April 24, 2014, 06:36:21 PM »
The Type 1 NPI Number belongs to who gets paid.  The Type 2 NPI Number belongs to who did the work.  Both of these NPI Numbers are registered with CMS in the National Plan and Provider Enumeration System (NPPES).  In this system, each NPI Number is associated with one specific Taxpayer ID Number or Employer ID Number (TIN or EIN).  Note that a provider can have both a Type 1 and a Type 2 NPI Number.  Both would be linked to that provider's TIN or EIN in the NPPES database.  One TIN or one EIN can be linked to two different NPI numbers.  One NPI Number cannot be linked to to different TINs or EINs.

Generally - you cannot get paid for Medicare billing without an NPI Number and a Taxpayer Number or Employer ID Number on the CMS 1500 Form (Boxes 25 and 33a).  The NPI Number and EIN provided to CMS will be run through their NPPES database.  They will continue to process the form only if those two numbers match what is in the NPPES database.  If they don't match, the CMS 1500 form (or its electronic equivalent) will be rejected.

More specifically - Box 33a must contain the Type 1 NPI Number for who gets paid.  The EIN connected to that Type 1 NPI Number in the CMS database must be placed into Box 25.  In the case of Group billing - where the Group has an EIN and a Type 1 NPI Number, these two numbers go into Boxes 25 and 33a, respectively.

The Type 2 NPI Number of who did the work goes into Box 24J.  The TIN or EIN for this Type 2 NPI Number is not placed onto the CMS 1500 Form.

You must follow the guidelines outlined above if you want to be paid by Medicare.  Whether individual commercial insurance carriers impose the same requirements depends on the carrier.

Now - regarding your question:  If the Type 1 NPI Number for who gets paid is placed into Box 33a on the CMS 1500 Form (as it is required by CMS), you must place the TIN or EIN that is registered with that NPI Number into Box 25.  If you don't do that, CMS will not pay you (except in error), and a given commercial carrier may or may not pay you - depending upon their internal rules.

You may not place into Box 25 the TIN or EIN of the one who did the work, if s/he is different than the one who gets paid.

Come back with more questions if you have them.


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Re: Tax Id
« Reply #2 on: April 25, 2014, 06:19:13 AM »
The Type 1 NPI Number belongs to who gets paid.  The Type 2 NPI Number belongs to who did the work.


I think you mixed these two up.  The type 1 is the individual, the who did the work and the type 2 is the organizational, or who gets paid.  Right??
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Re: Tax Id
« Reply #3 on: May 07, 2014, 07:55:18 PM »
Michelle- Agreed.