If you are new to healthcare or medical billing or planning to start practice then you must be familiar with National Provider Identifier NPIs.

After reading this guide you would deeply understand the importance, usage, and eligibility of NPIs.

Before explaining let’s have a brief overview of what’s inside this blog:

NPIs are the unique 10-digit identifiers used by healthcare providers in the United States, it is important in credentialing. These number sequences describe the type of services you are providing and to whom you are providing them.
Let’s have a deeper discussion over the types of NPIs, the differences between them, or mistakes to avoid.

What is an NPI?

National Provider Identifiers are the HIPAA covered entities and remain same, once issued. Each transaction or claim that came under HIPAA must contain NPI. Ignorance in NPI verification is the most common cause of denied or rejected claims.

It is a 10-digit unique number for the identification of healthcare providers or organizations. It doesn’t include geographical or biological data of healthcare providers, which means a little change in address or any contact number doesn’t impact the NPI. 

CMS

It stands for Centre Of Medicare or Medicaid Services. It is a governing body for the maintenance and issuance of NPIs, it regulates the verifications of NPIs. Its main function is to improve the efficiency and accuracy of NPI. 

NPPES

It stands for National Plan and Provider Enumeration System, used to sign the NPI number. It serves as the center for storing and maintaining databases used for NPI verifications. It ensures the accuracy and integrity of NPI.

Let’s discuss the types of NPIs that would be differentiated on the basis of who they work for:

NPI Type I

Definition:

This type of NPI is specifically designated for individual healthcare providers.  It is a 10-digit unique code allocated for any solo or individual practitioner as compared to any organization or clinic. NPI Type 1 represents the 1-1 service, in which a patient is directly collaborated with a physician without any involvement of 3rd party. Every payment transaction or claim would be conducted between them.

Eligibility:

Doctors, nurses, therapists, and psychologists are eligible for NPI type 1 and get reimbursed through through that number. This number indicates their specific and unique identity as a healthcare provider helps them in timely reimbursements and lets them continue their practice without any financial constrain.

Key features:

Some of the key features of NPI type 1 include:

• An important element for streamlining the verification process. It plays a vital role in credentialling and verification of services or providers.
• This type of NPI is associated with a Social Security Number (SSN).
• It is a never-changing number code that would be tied up to a practitioner throughout their career. It wouldn’t be changed with minor changes in your demographic database.
• This number is associated with HIPPA and so regulated the transactions more smoothly.
• For a licensed practitioner it is necessary to continue their practice in the United States.
• It is necessary for smooth claim submissions. Missing or incorrect NPI type 1 number would cause denied or rejected claims.

Application Process:

Application of NPI Type 1 can be processed through the National Plan and Provider Enumeration System (NPPES). 

• For application, a healthcare provider simply needs to visit the NPPES official website and enter your information.
• It’s a free-of-cost process, you just need to add your accurate name, address, contact number, etc.
• In addition to that you are required to add an accurate social security number and Tax Pyer Identification Number.
• Once the application is processed, you will get your NPI Type 1 soon.

NPI Type II

Definition:

This type of NPI is specifically designated for Groups o or organizations of healthcare providers.  It is a 10-digit unique code allocated for any organization or group of healthcare providers, each entity of that group would be able to bill to the payer.  NPI Type II is associated with an Employer Identification Number EIN. This type of NPI is Useful in payments that include Medicaid, Medicare, and insurance companies. 

Eligibility:

Billing organizations or groups are eligible for NPI type 2 and get reimbursed through that number. This number indicates their group identity as a healthcare provider and helps them in claim submissions for timely reimbursements. This NPI is useful for hospitals, laboratories, home health agencies, group practices, etc

Key Features:

• It is also known as organizational NPI associated with healthcare organizations.
• It just remains owned by the organization and not by any entities of that organization.
• It is a non-transferable NPI and remains the same throughout the service time period, till the owner of that organization is changed or replaced.
• It is a useful factor required for billing and claim submissions.
• It includes multiple locations or branches of any organization and remains the same for every branch.
• It is essential for electronic health transactions.

Application Process:

Just Like NPI Type I, it is also processed through the National Plan and Provider Enumeration System (NPPES). 

• Visit the official website of NPPES.
• Get registered there as a new applicant,
• Entered all the business details. 
• Select the taxonomy code that best represents your business or organization.
• After that provide official information including information of the CEO.
• Submit the application and wait for the response.
  This is how you can easily get your NPI Type II.

Leveraging Professional Help

NPI plays an important role in medical billing and it improves credentialling. But, getting NPI of your professional practice is not a piece of cake, you have to face some underlying issues and hidden errors that would cause unnecessary delays.

If you are having any difficulty in getting NPI seek professional help from Marvelous Medical Billing company and let the cash flow without any financial constraints. We are a team of medical billing and coding experts, who proficiently manage your complex billing tasks and improve the financial health of your healthcare practice.