Author Topic: Can we bill Medicare for the same NPI from different clearing houses?  (Read 930 times)

pazamba

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We are going to use two different EMR systems and two different clearing houses. Can we register the same provider with the same NPI in Medicare to send claims from those two different systems? The provider stays in the same state.

Please share your experience if somebody had similar issue.

Thanks,
Alex

PMRNC

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Re: Can we bill Medicare for the same NPI from different clearing houses?
« Reply #1 on: November 22, 2016, 06:49:14 AM »
No, you can only use one clearinghouse per NPI/Provider. Why do you need two clearinghouses/systems?
Linda Walker
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Michele

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Re: Can we bill Medicare for the same NPI from different clearing houses?
« Reply #2 on: November 22, 2016, 07:46:44 AM »
I would call the MAC to find out.  We have had situations where we were taking over an account but the old service, or the provider's in house staff were still working to clear up old billing.  We were able to get set up with our new EDI through our clearinghouse while they maintained their connection as well.  We've also done some work where we did not take on the entire billing but needed to be able to submit some claims and set up independently then as well.  I do believe Linda is right that they say only one per NPI however I think that there are ways to do it. 
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pazamba

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Re: Can we bill Medicare for the same NPI from different clearing houses?
« Reply #3 on: November 22, 2016, 10:29:45 AM »
Linda:

Currently we use EMR (eClinicalWorks/eCW) where we should pay license and monthly fees per NPI. We are going to expand our services with physical therapy. If we continue with the same EMR we need to to pay licenses and monthly fees for all physical therapists. They are going to be billed as rendering providers under our group billing NPI. We can't change our main EMR because of ACO agreement. So, we are looking to use our group NPI as a billing NPI with another billing program that we already have (Lytec).
For this reason I asked how it is possible to submit claims from two different EMRs and two different clearing houses.

PMRNC

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Re: Can we bill Medicare for the same NPI from different clearing houses?
« Reply #4 on: November 22, 2016, 01:07:36 PM »
Like Michele said there could be a few exceptions so you want to make a phone call to your local MAC. As far as I know you can't have two clearinghouse connections with one NPI.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com