NPI Number - Using It Properly For Billing

Everyone seems to be adjusting well to the use of the new ‘here to stay’ NPI number. People don’t act like they don’t know what you are talking about at least! Now there just seems to be some confusion over which NPI number goes where when you are billing.

There are several places on the CMS 1500 form for NPI numbers. Box 17b is for the referring provider’s NPI number. If there is a referring provider in box 17, then you should enter his/her individual NPI number in box 17b. (If the provider is part of a group and the group has a Type II NPI number, you do not want to enter the group NPI in box 17b.) Entering the individual NPI number in box 17b is important because the purpose is to identify the individual provider who referred the patient for the services.

Box 24j is for the individual NPI number of the provider who rendered the services that are being billed. For example, if you are a physical therapy group, you would put the individual NPI number for the therapist who worked on the patient. This box is used by the insurance companies to identify the provider who performed the service, it is not used for payment purposes. Meaning that payment will not be issued to the owner of the NPI number in box 24j.

Box 32a is for the NPI number of the provider/facility entered in box 32. This would be the provider’s office or facility where the services where rendered. If you are a group with several individual providers, more than one location, you would enter the NPI number for the location that the services were provided at.

Box 33a is for the NPI number of the provider/facility entered in box 33. This is the provider/facility’s billing location. The NPI number that is entered here determines who payment is made to. Payment will be made to whoever the NPI number in box 33a is assigned to.

If you are a solo practitioner with one individual NPI number (no group NPI), one location you would enter your individual NPI number in box 24j, 32a and 33a. If you are a large group with multiple locations and one central billing office, then you would enter the rendering provider’s NPI in box 24J, the group NPI for the facility where the services were rendered in box 32a, and the central billing’s group NPI in box 33a.

If a provider works for more than one group, or works for a group but also does private practice on the side, it is important that they enter the NPI’s correctly. Their individual NPI would go in 24j to identify who performed the services. The entity that they are working under when they perform the services, or that they want the payment to be made to, goes in box 32a and 33a.

Now that everybody seems to have their NPI numbers, they just need to know how and when to use them. It may seem confusing but it’s really not too bad. You just need to take the time to understand what each box on the CMS form is used for.

EFT Vs Electronic Remits

Everything about insurance billing today is electronic. Electronic medical records, electronic claims submissions, electronic funds transfers, etc. It can all get a little overwhelming.

Not only do insurance companies want you to submit your claims electronically, but they want to reimburse you by transferring your funds to you electronically and stop sending you paper eobs in the mail.

EFT, or electronic funds transfer, is now being mandated by some carriers such as Upstate Medicare in New York. EFT is when the insurance carrier transfers funds (or your checks) directly into your bank account instead of sending you a paper check.

Electronic remittances is when you receive your eobs via the internet instead of on paper. In some cases you can still receive paper eobs even if you have your funds transferred electronically.

In any case it is important that you understand the difference between EFT and electronic remittances. Insurance companies will be contacting providers trying to get them to enroll in both of these services.

Both EFT and electronic remittances are big money savers for insurance carriers. It cuts costs in paper, postage, printing, employee wages, and much more.

EFT and electronic remittances can also be a savings for the provider as well. When funds are transferred electronically, they usually are deposited into the bank account a day or two before the check would have arrived. There is no chance of the check being lost or stolen if it is electronically transferred.

When you receive your eobs electronically you can store them on your hard drive and not have to store the paper copy in a file cabinet. This can cut down on space needed for filing. With Medicare eobs you can print out the eob for the secondaries for each individual patient. This saves you from having to block off the other patients information and photocopying the eob.


Technology just keeps on going and we have no choice but to go along with it. The best way to deal with it is to understand what each choice offers. My advice is to educate yourself on what's out there and make it work for you.