Important Billing Identifiers for Therapists
Submitting a claim for insurance can be thought of like using a key to open a lock. When you complete an application for credentialing, the insurance company uses all of the information that you submit to create the lock. When submitting a claim, the information that you fill in on the claim submission form creates the “key” to open that lock. If any of the information on the key does not match the lock, the claim will be rejected, similar to a lock not opening for an incorrect key. The purpose of this article is to go over some of the important identifiers that make up
your “key” to insurance billing.
Does your name have an uncommon spelling, or include a middle initial? Have you legally changed your name recently? Has your business changed its name, or does it operate under an acronym? These are all possible circumstances that could yield issues in the “key” not matching the “lock” when it comes to insurance claim processing. Double check that when you are credentialing, the information that you include in your name for either yourself or your business is recorded correctly so that you can include the exact same information on every claim submitted.
National Provider Identifier
The NPI, otherwise known as the National Provider identifier, is a ten digit number that every therapist filing insurance claims should have. This number is not specific to therapists; every healthcare provider who is submitting insurance claims should have an NPI number. In the past, providers had different identification numbers for each insurance company. In order to standardize, the National Plan and Provider Enumeration system was developed to assign providers one identifier that they would use across all insurance companies. That being said, there are two different types of NPI number and a provider may have both types. If you are unsure of your NPI number, or which type of NPI number it is, you can reference the NPPES NPI Registry to look up your information.
NPI Type 1
This is otherwise known as an Individual NPI. Every provider who intends to credential with an insurance company and submit claims for reimbursement should have a type 1 NPI, even if they are part of a group.
NPI Type 2
This is otherwise known as the Group NPI. This NPI gets assigned to a group organization so that many providers can submit under a single NPI. Not every provider will have a group NPI. If your practice chooses to bill as a group, the individual NPI may still appear on the claim as the rendering provider, but the group NPI would be used as the billing NPI.
Tax ID Number
The tax ID number is a government issued ID number used for tax purposes. Checks issued from the insurance company are like paychecks, and the Tax ID must be associated with these payments to report income. There are two different types of Tax ID that you may have, but you must have one or the other registered with an insurance company.
Social Security Number (SSN)
The Social Security Number is your own personal social security number issued by the IRS, formatted XXX-XX-XXXX. In general if you are filing claims as an individual rather than a business, you would use this number when you fill out your credentialing paperwork as well as when you submit claims.
Employer Identification Number (EIN)
The EIN is also a nine digit number, formatted XX-XXXXXXX issued by the IRS. In order to obtain an EIN number, you must fill out an application with the IRS using your business information. Even if you are a solo practitioner, you can still apply for an EIN rather than using your SSN for credentialing and billing. Once you complete the application and it is reviewed, the IRS will issue your EIN number, which should be kept with the same regard as your SSN. Keep this number protected, but also have it readily available for billing purposes!
Your address is one of the identifiers for your “key” to billing, yet is often the most problematic because it can be difficult to remember to update it when you move, or start operating out of an office instead of your home. When you credential, make note of the address that was used. If your practice ever starts operating from a different address, make sure to update your credentials to reflect the new address.
The billing address is typically the address where you or your office are physically located, and is used for claim submission. Unless you have a separate mailing address on file, this is where all important information will be sent to you by the insurance company, including paper checks if that is your preferred reimbursement method.
Insurance companies may allow you to have a separate mailing address established. This can be helpful if you would prefer to have all correspondence sent to a specific address such as a home address, but have been credentialed using a different address such as an office address. As long as you are still associated with both locations, you can establish a mailing address, yet still use the billing address on the claim submission form so that the claim can be properly processed.
If you ever decide to move, either your billing address or your mailing address, and you are no longer associated with a specific address, always be sure to update this information with the insurance company as soon as possible in order to avoid any confusion.
Insurance Specific Identifiers
If you applied to be a Medicare Administrative Contractor and your application was approved, you will have been issued a Provider Transaction Access Number (PTAN). This number will need to be included on claim submissions to Medicare.
Medicaid: Provider ID
In some states, the Medicaid Provider ID is just the NPI number that you used to credential with. In other states, Medicaid will issue a separate Provider ID number that will need to be included on claim submissions.
Other Insurance Providers
It is not very common, but there are a few other insurance companies that will issue you their own identifying numbers. When you are credentialed and you receive any contracts, welcome packets, or correspondence indicating that you are credentialed, read everything carefully and keep an eye out for identifying numbers that may be important to store.
If you are a Medicare provider, you will need to know your taxonomy code. This is something that you will need to know in order to apply to be a medicare provider, and the taxonomy code submitted on any claims must match the taxonomy code that was submitted on your application to become a Medicare provider. Your taxonomy code is determined by the type of provider you are, as well as your specialty. If you do not already know your taxonomy code, you can review this article from the Centers for Medicare and Medicaid Services website.
When it comes to billing, there are a lot of little details that need to be tended to in order for claims to process correctly. If detail orientation is not your strong suit, or you feel that your time would be better spent with your patients rather than combing through claims, reach out to Practice Solutions! Your dedicated biller will handle your billing from claim submission to payment posting. Contact us on our website, give us a call (734-437-9432) or email us at firstname.lastname@example.org.