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Single Member LLC- NPI Type Question

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You are most welcome!   ;D

I have a question on this same topic. I am a medical biller for mental health therapists. One of my LMFT's has several interns and is now wanting to become a group. She is getting things ready to switch to an LLC and get her group NPI. Regarding billing to insurance, she is both in and out of network. I will need to update her NPI with all her insurance companies, will this be my only change regarding updating her practice information and will it affect her in network status? I am thinking it should be basically an NPI update? Also, will I only be billing with the NPI 2?

Thank you, Jennifer

Insurance companies contract with individual providers in the scenario you present. So I don't see that her forming a group practice under the LLC and getting an organizational NPI will effect her network status with insurances she is already contracted with.

As far as billing goes, the individual provider name/NPI will go into the rendering provider area, and the billing provider area will be populated by the group name/NPI on the CMS-1500, as the group practice will now get all the payments from insurance.

If any of the providers are contracted with Medicare, each provider will have to update their Medicare enrollment at PECOS to reassign benefits to the group practice, also.

In addition to what Kristin said, if she will be billing under an EIN then you may have to register the EIN with the insurance carriers that she wants to be in network with.  If she is billing under the group NPI and EIN then they may need to credential that EIN as well.

Thank you for this information. This provider is out of network with all insurance companies except Partnership (California). My plan was to update her group NPI and business name change with all insurance companies correct? At what point should I update my software? Right away I am thinking? I just do not want to update if this could cause a denial.

Thank you, Jennifer


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