NPI Numbers > NPI Numbers
Group or Individual NPI
Michele:
The address on the NPI system does not affect the payment if payment is going to the group, but the provider should have accurate info on the NPI system. You would need to contact the insurance carriers to have the providers credentialed under the group. That will link their individual NPI to the group. Also, if the provider is credentialed with both a private practice and under the group (billing under different tax ID's) then they can bill their private practice under their individual NPI and the services with the group using the group NPI (with their individual NPI as the rendering provider).
Many doctors have both an individual and a group NPI.
Michele
jcbilling:
Michele,
One of the DC's that is not linked to the group is currently billing under the main dr's individual NPI # - which I know is wrong and I'm trying to correct. First, the dc needs to fill out a CMS 855R to be linked to the group, right?
But until that happens, I'm considering billing under his individual NPI. The only problem is that he works out of another location in another city part time -and that is the address that his individual NPI reflects on the Enumerator system. So if I submit claims with his individual npi, how do i keep payments from going to the part time office and instead come to the office where I do the billing for? I'm thinking it's the facility address, but I'm not sure.
Do you have any suggestions?
Thanks,
Charity
Michele:
If you bill under that Dr's individual NPI before you link him to the group the claims will probably be denied stating that the ind provider wasn't eligible to bill under the group on the date of service. If they do pay, it will go to the private practice, not your group. There is no way around that without doing the 855R form. Just date it for when you need to start billing, then hold claims until the 855R is processed. That would be the best way to go.
Michele
mbenedict:
Hi, I'm Marjie and I work for an optometrist that accepts Medicare. I just completed the mess of paper work required by MCare for a change in the doctor's tax status from sole proprietor to Inc. PA. I finally got the go ahead, the changes and requirements from MCare had been met so I then billed the claims I needed to. MCare rejected every one and I'm confused as to how to use the NPI attaced to the doctor herself and the group NPI. I filled out 24 J with her personal pin and box 32 & 33 with the group pin. It's only one doctor, so should I use the group NPI that is attached to her new tax ID in 24J and 32, 33? thank you for any help. (I have talked to mcare reps and read the online instructions in the mcare manual and I get different answers!)
Michele:
If Medicare has assigned the dr a group PTAN for her group name and group NPI, and an individual PTAN under her individual NPI, then you would bill with her individual PTAN in box 24J and group PTAN in 32 & 33 A. But if Medicare only assigned 1 PTAN, then it would be different. You would need to leave 24J blank and use the NPI that Medicare is using in 32 & 33 A. When Medicare updated your changes they should have sent you a letter advising you of the update and showing the PTAN, NPI and tax ID they currently have on file. If you don't have that letter, call Medicare and ask what NPI they have linked to the dr's PTAN. Even though we don't use PTAN's on the claim anymore they are still a big part of billing.
Michele
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