NPI Type 1 vs. NPI Type 2 – What You Need to Know
A NPI can be either Type 1 for a single healthcare worker or Type 2 for a healthcare group.
Type 1 and type 2 NPIs are the same except for who they are for. Type 1 NPI tells you who provided the service, so you can be sure that your claims are accurate. Type 2 NPI tells you which company is billing for services, which makes it easier for the group to get paid.
To put it simply, NPI Type 1 is for individual health care workers like dentists and family doctors, while NPI Type 2 is for businesses that are organized, like hospitals, groups, and offices. This is also why they are known as Individual NPI and group NPI.
With a Type 2 NPI, a healthcare practice or group can get credentialed with a payer at the same time. This makes it easy for all the doctors in that practice to bill under the same corporate identifier.
Do You Need Type 1, Type 2 or Both?
Depending on how your business is set up, you may need a Type 1 or Type 2 NPI. Allow us to explain it with the help of a doctor.
Solo Practitioner
You only need a Type 1 National Provider Identifier if you work alone as a provider. This is true if you use your name and Social Security number to file claims.
Individual Dentist at One Practice Location
You need a Type 1 NPI for yourself and a Type 2 NPI for your business. If you file claims under the practice’s name and Tax Identification Number (TIN), you need to do this.
Multiple Dentists at One Practice Location
Each doctor needs a Type 1 NPI, and if claims are sent in with the practice’s name and TIN, the practice itself needs a Type 2 NPI.
Multiple Dentists at Multiple Practices
Each dentist should have their own Type 1 NPI, and if they each have their own TIN, each office needs to have a Type 2 NPI as well.
Having the right NPI is important for accurate billing and HIPAA compliance, no matter if you are a sole practitioner or part of a bigger company. Making sure that your NPI information matches up with your payer information is important to avoid having your claims denied or registration problems.
FAQs About the National Provider Identifier (NPI)
What is an NPI in Healthcare?
The National Provider Identifier (NPI) is a 10-digit number that can only be used by one healthcare provider in internet operations. This number makes it easier for doctors to talk to each other and handle health information. It is required by HIPAA. For correct bills, each NPI is unique and doesn’t change over time.
Key Points About NPI:
- Each NPI is a unique number that can only be used by one provider or group.
- There is no coding information about the service on the number.
- NPIs never go away or change.
- NPIs take the place of older transaction identifiers like Blue Cross or Medicaid cards.
- An NPI can be applied for by any healthcare worker or group.
- Required for all healthcare professionals who send data online.
Who needs to have an NPI number?
Under the NPI standard, healthcare providers are “covered entities” and must get a National Provider Identifier (NPI) if they:
- Send claims online.
- If you have claims, use a broker.
- Send documents for claims online
- Check online for qualifications or claim files
How do I get an NPI number on the web?
The steps to get your NPI are easy:
- To make or manage an account, go to the NPPES website and click on The Account button.
- To send the application by mail or online, fill it out and follow the directions. (Submissions by fax are not accepted.)
In a few hours to five work days, you’ll get an email with your NPI. But applications sent by mail could take up to 20 days to be processed.
Why would you need an NPI number?
If you are a healthcare worker or business owner, you are needed by law to get an NPI number. This lets people find you and your services. But having an NPI helps you in many ways, like making it easier to identify yourself, letting you choose where to work, and saving you money.
- Using a single name makes deals easier between multiple providers.
- You don't need new IDs if you move or change your field.
- lowers the cost of administration and makes healthcare deals easier.
If I send paper claims, do I need an NPI?
No, you don’t need an NPI if you only send paper reports and don’t use the internet to check their benefits. Under HIPAA, you don’t need an NPI if you don’t do any internet activities. But getting one is still a good idea because it can make dealing with different payers easier by giving you a unique ID.
Who gives Providers their NPI?
Health care providers in the US are given an NPI by the Centers for Medicare and Medicaid Services (CMS) through the National Plan & Provider Enumeration System (NPPES).
What changes will the NPI make to the other IDs I’ve used?
The NPI takes the place of several other identification numbers that are used for online purchases. These include the Medicaid, Blue Cross and Blue Shield, UPIN, and CHAMPUS numbers. But it doesn’t take the place of Social Security, DEA, or Tax Identification numbers because they are used for different things.
How do I connect different service providers to a group contract?
Each payer or insurance company has its own rules about how to connect individual providers to a group contract. Some may need an email, others a fax, and still others an online site. You will have to fill out an application and give more paperwork, though.
Can I be credentialed at multiple places with multiple employers?
Yes, you can have credentials in more than one place. Just keep in mind that if one company is not in network with a payer but another is, it could cause problems with paying for both.
What place can I go to get help with the NPI form?
Medphoenix RCM has made it very easy to register for an NPI. We help you speed up the whole process and make changes to your NPPES information while you’re out and about. You can talk to our healthcare business expert for free.
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