Question credentialing question please


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can you use the npi of one group and the tax id of a different group ???
i was told yes
i dont agree
if we call insurance and give them our npi and tax id they say we are OON
if we call and give them our npi with one of our other groups tax id it is IN Network ????
any help would be appreciated


Pasadena/LaPorte Texas Chapter
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Talk to your managed care department and let them know what is going on. They need to contact their enrollment contact to ensure all related tax IDs associated with the enrolled provider are part of the enrollment.
You must use the NPI and tax ID specific to the location where the service was rendered. Do not change either of the two in order to receive a better reimbursement or coverage.


True Blue
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There are two types of NPI numbers - one for the group and one for the individual provider. I'm not sure which NPI numbers you are referring to in your question, so there isn't really enough information here to be able to answer your question. The group NPI numbers will be associated with a specific tax ID number. The individual providers a required to assign their benefits to a group in order for their NPI to be billed under that tax ID, but individual providers may be assigned to more than one tax ID because a provider can be employed by more than one group at the same time. These arrangements need to be communicated to your payers during the credentialing process. So if you are getting conflicting information from the payer about which NPIs are associated with which tax ID numbers and who is in the network or not, there are a lot of different factors that could cause this discrepancy. You'll need to look a little closer at what is happening in order to get to an answer.