NPI Number Individual or Group – Which One Do I Use?

March 31, 2017 Off By

There is so much talk about getting your NPI number. You must have it by May 23rd or your cash flow can be severely affected. Do not wait till the last minute to get it because you will need to report it to all of the different insurance carriers. But if you had to apply for two NPI numbers, an individual one and a group one, which one do you use to submit claims?

Most insurance carriers including Medicare require the individual NPI number on the claim in box 33a. If you are doing paper claims, enter your individual NPI number in box 33a on the CMS 1500 form. If you also have a group NPI number, it should be placed in box 32a of the CMS 1500 form.

If you submit your insurance claims electronically you may need to test your claims once you have your NPI number loaded. For your paper claims, you need to update your software to be ready for the new CMS 1500 forms which allow for the reporting of the NPI number.

You may also be receiving requests from colleges notifying you of their NPI number and asking for yours. It is necessary to share your NPI number with other medical service providers because when you refer a patient to another provider or if another provider indicates a patient to you, you may need to include that provider's NPI number on the claim form.

NPI numbers are here to stay so there is no use trying to avoid them. The more you learn about them, the easier it is to understand how to use them. The first step is to get one, so if you have not already obtained your NPI number, you really should do it immediately.

Copyright 2007 – Michele Redmond