NPI Numbers > NPI Numbers

Group or Individual NPI

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jcbilling:
Hello everyone!

First, I wanted to tell Alice & Michele how much I appreciate this forum and their resourceful website. It is very encouraging to me to have it available.

Secondly, I recently signed a contract with 4 doctors - three are chiropractors and one is a family practitioner. There are three locations, with the main chiropractor and family practitioner practicing in the same office and the other two chiropractors have two separate locations. The main chiropractor asked if they need to bill under a group NPI or individual NPI. Right now, all the family practitioner's claims are under his NPI, but they practice in the same building. He recently left the local hospital to practice with the chiropractor.  All four of the providers have individual NPI's, but one currently bills under the main chiro's NPI - which I told him I didn't think was right - he agreed.

Now that I have everyone confused, myself included :) how do I find out how it ought to be done - group or individual?

Also, the family practitioner was credentialed with local hospital and has a Medicare number. Does he need to do anything to become credentialed to practice in the new location. They want to be in network with BCBS only.

Thanks so much!

 - Charity

Michele:
Hi Charity,
   So glad you like our website/forum.  We love to hear it. 

Regarding the 4 drs, if they all bill under one group name and tax ID# then you would bill all under one group npi number in box 32a and 33a.  But you would use their individual NPI #'s in box 24J to show the rendering provider.  However, you must make sure all providers are 'linked' to the group NPI with the insurance carriers you are billing for. 

If the family practitioner was credentialed with the hospital you need to make sure he is now credentialed under the group he is with.  He doesn't need to start from scratch, he just needs to notify the insurance carriers that he has left the hospital and joined a group.  If he doesn't want to be a Medicare provider anymore he should deactivate his Medicare number.  However, if he is considering taking Medicare at the new location, then he just needs to notify Medicare that he switched locations.  He would do that with an 855I form.

Michele

jcbilling:
Thank you so much Michele! I appreciate your willingness to help and for making my complicated question so simple :)

I do have a follow-up question: Do I need to have all 4 doctors sign a contract? or just the head of the group?

 - Charity

Michele:
If you mean a contract with you as a billing service, you just need one person to sign for the whole group.

No problem, we love to help!

Thanks
Michele

LW5689:
Michele,
I am going to begin billing for a PT and I am somewhat confused about exactly where to put his NPI#.  I believe I need to put it in 24J and 33a but wasnt sure if I needed to put it in 32a?  He treats patients at a few different facilities and I just wasnt sure if I needed to put his NPI in 33a or if a separate facility NPI goes there?  Thank you so much.  Lori

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