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Nurse Practitioner

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RichardP:
Not all carriers require an NPI Number in Box 24J.  But when a number is required, it must be the Type 1 NPI Number - which designates who did the work.  In the case of a sole proprietor (incorporated or not), both numbers (Box 33a and 24J if required) belong to the sole proprietor.  If the sole proprietor hires someone to help him, the Type 1 NPI Number of the employee who did the work goes in Box 24J, if a number is required.  The Type 2 NPI Number of the sole proprietor (the billing entity who gets paid) goes in Box 33a.

Again - a service provider, regardless of whether individual or coporate, can hire folks to help get the work done.  The billing entity would be the entity doing the hiring.  The billing entity's Type 2 NPI Number (who gets paid) goes in Box 33a.  That billing entity's contractual relationship with each insurance carrier governs the billing transaction - regardless of who actually does the work.  The Type 1 NPI Number of whoever does the work goes in Box 24J only if it is required by the insurance carrier.  If the carrier does not require an NPI Number in Box 24J, they will have no reason to know that the doctor was not the one who did the work.  With regular medical care, so long as the MD (or his corporation of one) is the billing entity, and bills under his Type 2 NPI Number, it does not matter what field the NP is board certified in.

Again, mental health billing has some requirements that are different from billing for regular medical care, so what I have said may need to be tweaked by someone who knows mental health billing.

rdmoore2003:
With the insurance companies that we are paneled with, do require NPI's across the board.  We just had a couple of providers leave our office and new ones came in.  When I had to panel with our insurances, we just had to add to our group contracts since they are already credentialled.  It really depends on the situation.  I had 1 provider that just got licensed and had to credential then add to our group.   I would suggest to contact your panelled insurances and see what they require.   As for the requirements on the NPI, I just make it standard practice to set each insurance to show the billing entity and also the rendering.  Seems more streamline and I have had absolutely no problems.  even when the 2013 codes changed, I had more stories of mental health providers all over the country not getting reimbursed and our office never really had any issue.

RichardP:

--- Quote from: rdmoore2003 on August 05, 2013, 05:42:25 PM ---We just had a couple of providers leave our office and new ones came in.  When I had to panel with our insurances, we just had to add to our group contracts since they are already credentialled. ...  I would suggest to contact your panelled insurances and see what they require.
--- End quote ---

Again, Regina, you are talking about the requirements for billing when the Group is the billing entity.  These requirements are different from the requirements for billing when a sole proprietor is the billing entity.  All indications are that the original question concerned a sole proprietor who has incorporated his business.  That is still a sole proprietorship, not a group.

Can you explain briefly what you mean by "... I had to panel with our insurances .  That phrasing is not familiar to me, but I assume you are describing something I know by another name or phrase.

rdmoore2003:
join network, panel, contracted

RichardP:
Thanks.

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