NPI I vs II

[trixter888]

Advertisement - Members don't see this ad

Can someone please provide clarification regarding NPI I vs NPI II and how it may apply to my situation?

Currently I own and operate a private practice which is out of network. I have been credentialed with my state’s Medicaid and Medicare with my NPI I, however have not been credentialed with any other private practice at this time. For my patients, I am supplying them with a superbill which has only my NPI I number. Separately, because my practice is an LLC I did apply for an NPI II which I really have not been using.

Recently my situation has changed personally, and I am now considering working for a telemedicine company. I am wondering however how this will affect my current practice, as they will likely want me to be credentialed with insurance companies.

Questions:
1) If I get credentialed with insurance companies, can I still operate my own OON private practice?
2) If I can continue operating my private practice, should I then use my NPI II for billing?
3) From my understanding most insurance companies credential a provider only at a certain location. So am I overthinking this?

Thank you so much for help in advance.

 

[Sushirolls]

1) Yes
2) Ideally yes, you should be using your NPI-II and NPI-I with claims submissions
3) Yes, you are overthinking but its good to in this case to head off claim nightmares.

I believe by consistently using and linking and doing your 90 day updates with NPI-II and NPI-I associations, that it will reduce the likelihood of claim misdirection. Possible, I'm wrong in this assessment. But also in this mix and more of an anchor than the NPI I/II issue, is the TAX ID NUMBER. This with its corresponding W-9 are more of the zip code insurance companies use for claim submission, IMO.

I have 1-2 companies that would use my NPI-II, I still submit it to them that way, but in their eyes the contract is just with my NPI-I and Tax ID number. The rest of my contracts are with my NPI-II and Tax ID number, I just happened to be the 'employed' doc providing the services for the company.