NPI Number - Everything You Need to Know About NPI …

1 NPI Number Everything You Need to know About NPI Numbers By Alice Scott and Michele Redmond What is an NPI Number , who needs one, how do you get one, when do you need two NPI # s, what is a taxonomy code and how does it affect my NPI #, how do you get someone else s NPI Number , and did I already get one are just a few of the questions that have arisen. The whole realm of NPI is confusing and since it just came into effect May 23, 2007 we re just beginning to see the challenges.

2 We are all learning together About how the change will affect our offices. We are still obtaining NPI numbers for providers who call and haven t gotten one yet. We are also answering many questions on our Ask the Biller page on NPI numbers. Here s our best at answering all these questions. What is an NPI Number ? Since May 23rd it is required that any provider of medical services must obtain a National Provider Identification Number . They are free and fairly easy to obtain. In order to be reimbursed by an insurance company the provider must now file all insurance claims on a new form that was designed to accommodate the NPI with the providers NPI Number in the correct boxes on the claim form.

3 There are two types of NPI numbers. A type I NPI is for any individual provider. A type II NPI is for any organization that renders health care services. 1 A little confusing? Not yet. It s coming. Keep reading. Who needs a NPI Number ? There is still some confusion over whether certain providers need to have an NPI. If you contact the NPI enumerator they can t even tell you. Nurse practitioners and physicians assistants need to have one as well as mid-wives. But RN s and LPN s do not. For example, there is not a specific taxonomy code (we will explain what a taxonomy code is later) for LMT s but they tell you to use the one that is under Other Taxonomy, then pick Specialist.

4 If you are billing insurances then it is a good idea to have one. Bottom line, the NPI numbers are free, and it s better to be safe than sorry. If I were you I would get one. So if you don t bill insurance companies you shouldn t need a NPI Number should you? Not necessarily. If you refer patients out to a specialist, your NPI Number is required by the insurance company for that specialist to be reimbursed. Life has a way of changing. Maybe you ll be billing insurance companies in the future. 2 How do you get a NPI Number ? The easiest way to get a NPI Number is to hire us to get it for you for $ Michele has obtained so many now she can get through the website application in four minutes while you are on the phone with her.

5 The assigned Number has been coming back to us the same day in many cases. You can call Michele at 1-800-490-4299. The NPI Number itself is free. You can fill out an application yourself at It takes About 15 20 minutes for a first time user. You can also download a paper application to send by mail. When does an office need two NPI Numbers? If an office is a group practice, with a group name and tax ID Number , then you would need a type II NPI for the group and a type I NPI for each provider within the group. For example, if you have a group named Smithtown Medical Group with 3 MD s and 2 NP s then you would need a type II NPI for the group Smithtown Medical Group, and 5 type I NPI numbers, 1 for each MD and NP.

6 If you are a single physician but you use a group name & tax ID# then you may still need both types of NPI s. If the insurance carriers have you credentialed as a group or if you want to be reimbursed under the group name & tax ID, then you would need both. I had an insurance company provider representative tell me that basically, whatever the name is that is associated with the NPI Number that is in box 33a of the CMS form is who the check will be made out to. 3 Does a physician who works at two offices need two NPI numbers? No. Each provider only needs 1 individual NPI Number , no matter how many locations, or offices they work at.

7 If you are a fee for service provider, why do you still need a NPI Number ? If you refer any patients out to a specialist that specialist needs your NPI Number to be reimbursed by the insurance company. These providers will not be able to accept referrals from you without a NPI Number for the billing. Why would a physician in a non-profit organization need a NPI Number ? Even if you are a physician who works for a non-profit organization you need to get an NPI Number . You may not be billing any insurance claims, but if you need to refer a patient to a specialist who does bill insurance they have to have your NPI Number , as the referring doctor, on the claim in order to get reimbursed.

8 Why does an ambulatory surgery center need a group NPI? Ambulatory Surger Centers must have a type II NPI Number in order to bill for the facility charges. Each physician who works at the Ambulatory Surgery Center also needs their own NPI. 4 What do you do if you think you have a NPI Number , but you don t know what or where it is? You need to call the NPI enumerator and be prepared to furnish your SS#, date of birth, etc to get any information. You can reach them at 1-800-465-3203. They can tell you if you have already applied and send you a new email if necessary.

9 What is a taxonomy code and why does it affect my NPI Number and my payments? Taxonomy Codes are an administrative code set for identifying the provider type and area of specialization for health care providers. They are alphanumeric and are ten characters in length. Taxonomy codes allow providers to identify their specialty. A provider can have more than one taxonomy code. Taxonomy Codes have 3 distinct levels. Level I is the provider type which is a major grouping of health care providers. For example: Dentists, Osteopathic Physicians, and Chiropractors. Level II is Classification or a more specific service or occupation related to the provider type.

10 Level III is the Area of Specialization. This is a more specialized area of the classification in which a provider chooses to practice or make services available. This is usually based upon the sub-specialty certificate. Taxonomy Codes allow the provider to identify their specialty at the claim level so this can directly affect your reimbursement from insurance companies. If you have an inaccurate taxonomy code linked to your NPI Number then your services may be paid at a lower reimbursement rate, or outright denied by an insurance company. 5 Example: If you are a Pediatric Surgeon and you pick a taxonomy code for just straight Pediatrics, your services may be denied.