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It isn’t simply sufficient for the provider to be credentialed with the insurance coverage carrier. Their particular person NPI should even be linked to the group’s NPI if the fee is to be made to the group. For example, say a provider is in network with their local BCBS but they are arrange individually beneath their SS# and their particular person NPI. Then they resolve to work half time for one more group. The group they are working for can not merely invoice BCBS with that provider’s individual NPI within the rendering provider field and their group NPI within the billing provider area and expect cost to be made to the group. Even when the provider is par with BCBS. The group must notify BCBS that the provider can be working for the group, along with their non-public apply. BCBS will link the provider’s individual NPI to the group’s NPI.
It is important to make sure that all providers that a gaggle can be billing for are set up accurately with the insurance carriers. Not having it set up correctly can cause enormous problems with the billing and can really mess up the accounts receivables. Understanding how the NPI’s work is the key.
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