Managing NPI Numbers / Medicaid IDs / Tricare

Adding Provider Identifiers (NPI/Tricare/Medicaid/Referring Provider)

A NPI (National Provider Identifier) & Tricare number is a unique ID for covered health care providers. These numbers are used on the CMS 1500 form as a way to identify the health care provider(s) for HIPPA standard transactions. 

Adding Provider Identifiers

1. From the left navigation menu navigate to Billing -> Provider Identifier.
   
2. On this screen you will notice General, Tricare ID, Medicaid ID, BHPN and Referring Provider tabs along the top of the screen.
   
3. Select the tab you would like to add an ID for.
   
4. Stay on the General tab if you are adding an NPI for a staff
   
5. Filters are automatically applied to show only staff with NPI numbers. Select "Clear All Filters" to show staff without NPI numbers
   
   
6. Locate the staff by scrolling or using the search at the top
   
7. Next, click the "-" under the NPI column to enter an NPI. Click the checkbox when completed.
   
   

On the General tab you can select whether or not the the staff/office NPI is used as a rendering provider, billing provider and service facility. 

Rendering provider:  This is an individual who provides the service to the patient.  Depending on the payer, you may only bill under a BCBA or the RBTs/BTs might have their own individual NPI number.  It is important to check your contract to see who should be the rendering provider for the service.   

Billing Provider:  The individual or entity that submits claims for health care services, equipment, or supplies delivered by an attending provider.  

Service Facility:  Name, full address and identifier of the place the services were rendered.  This will typically be your office or clinic address registered to your organization, not the client home.

***Most organizations should have a group NPI number which will typically serve as the billing provider and the service facility.  Individual providers have their own individual NPI numbers; these will typically serve as the rendering providers.  Often only the BCBAs have their own NPI number depending on which payers you are working with.   Sometimes BCBAs will only bill under their personal NPI number depending on how the credentialling was completed.  Make sure to note in your contract whether you are credentialed under your group NPI or personal NPI.

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