This is a 2 part post.
Effective 6/1/23, we started billing Medicare with a group tax id # as well as an NPI2, instead of sole proprietors Tax id & NPI1. Unfortunately, we did not update our information with the secondary insurance (Optum) to which a majority of those claims crossover at the same time. As a result, all of those claims have been processed as out of network regardless of all 4 providers being in network as individuals. We submitted what we thought was a group application for Optum and now, 6 months later, we find out that the plan does not credential chiropractic groups. Providers have to remain INN as individuals. Optum did at least confirm that the tax ID on file for the providers has been switched from the individual TIN to the new group TIN effective 10/31/23. My questions are:
1. Going forward, how are we supposed to bill Medicare with the group info (TIN & NPI2), if the secondary insurance does not recognize us a group? The claims will continue to be processed as out of network as per rep. To add to it, Medicare terminated all 4 providers as individuals effective 6/1/23 and they are only identified as part of the group now.
2. Re: The claims from 6/1/23 - 10/31/23 that were processed as out of network because the TIN did not match Provider's info on file...Optum suggested we submit corrected claims for all visits in that timeframe with the individual tax ids that were in effect at the time + the individual NPIs. Are we permitted to bill MCR with the group tax id and then manually rebill the secondary insurance with the individual tax id?
I hope this all makes sense. We are in a real mess and I need to get it fixed quickly! Any input would be appreciated. Thank you!
