Having a hard time sorting out the information on file with insurance companies you’re in-network with?  Getting rejected claims stating you’re out of network when you know you’re in network?

This guide will help you understand one reason why: your NPI and Tax ID information is mismatched and registered incorrectly.

(There are many reasons for rejections, another being mismatching office location information, among others.  We help our providers sort this information out in a stress free manner.  If you’d like help with our billing service, shoot us a line.)

Tax IDs:

Your Tax ID can be either your social security number (SSN) or, if you have registered a business, your employment identification number (E-IN).  On any CMS1500 claim form you are going to select one or the other in a tick box to detail which tax ID you are using to file your claims.

NPIs:

You will have an individual NPI number associated with your name, address, license, and all of that is public.  You can google your NPI, heads up!  Likewise, you may have registered an organization NPI number.  This will be associated with a business entity.

Putting It Together

Each insurance company will have an NPI and Tax ID on file and in-network, if you’ve been credentialed and accepted on their panel.  This means that you can have one of the following four combinations:

• SSN + Individual NPI
• EIN + Individual NPI
• SSN + Group NPI
• EIN + Group NPI

Of the four combinations above, having an SSN associated with your group NPI is extremely rare, so applying pareto’s law and our expertise, you can assume that in the above equation, the bolded options are most likely.

Sorting It Out

The best way to go about figuring this information out is to stay organized.  Create a spreadsheet with each insurance panel you apply to and make sure you record the NPI, tax ID, and address you’re submitting with your application.  You’ll save time and frustration.  Ideally you use the same information throughout, making the process that much simpler.  Before applying to any panels, if you do want to create a business and organization NPI, do so immediately and use that information from the get go.

Let’s say you’re less than perfect and there’s disparate information across the panels you’re working with.  It happens.

What’s the best way to sort it out?  Frankly, getting on that damn phone and calling.  When you have a new patient, call to check eligibility and benefits (script in link), and during that call make sure to confirm your network status, giving the operator both your NPI and tax ID.  If they don’t see your information, try other combinations until you find the right data in their system.  Then record it in that spreadsheet we just talked about.

Questions?  Head to our ask a mental health billing expert a question page to submit one of your own.