NPI Numbers Which One To Use

Everyday I get at least one question on which NPI number is used for what purpose. There is still a lot of confusion out there.

If you have a tax ID# and a group name then you would have a group NPI number (type II) and then an individual NPI number (type I) for each individual provider within the group. When you bill you would indicate the individual provider who performed the services NPI number
in box 24K on the CMS form. Then you would indicate the group NPI number in box 32a and 33a.
The NPI that is in box 33a is who the insurance carrier will make payment to. For example, if you have 2 providers in your group and you put one of the provider's individual (type I) NPI number in box 33a, then the check will be made out to that individual provider instead of the group. You need to put the individual's NPI in box 24K and the group NPI in 33a.

Another common question is "Why do I need 2 NPI numbers if I am the only provider in the group?" Well, even if you are a solo provider but you are using a group name and tax ID# then you will need that second NPI number to be paid properly by the insurance companies. The individual NPI is associated with a provider's social security number, not a tax ID#. If you want your payment under your tax ID# then you need to have a group NPI to bill under.

Whether you agree with how they developed the system or not, if you don't use the NPI numbers the way they were intended to be used you won't be reimbursed properly for your services. So I guess we will all just have to play along by their rules!

Play nice :)

Michele


P.S. For more information on NPI numbers and how to get them visit my webpage on NPI numbers.