Being a healthcare provider, have you ever faced a situation where your claim keeps on getting rejected by the insurance companies because they believe that you are out of network, while in reality, you are in-network?
If your answer is no, then my friend, you are one very lucky person! But if it is yes, because obviously, this scenario is more common than you could ever think of, you would back us when we say that it is the most frustrating thing ever! Right?
Many healthcare providers often face multiple difficulties while sorting out the information on file with the insurance companies they are in-network with. And disparities in important details usually leads to the rejection of the entire insurance claim. If you have ever faced such a situation, we get you, and we are here to help you out!
First things first, do you know what the most common reason why this happens is? The answer is simpler than you think. More often than not, the reason for your claims to get rejected is that your Tax ID and NPI, that is, National Provider Identifier, information are mismatched and recorded incorrectly.
But before you start worrying, hear us out. Sorting out these two pieces of information and figuring out whether you are in-network or not is not a very complicated task. And that is exactly what we aim to do in this article. We are going to explain to you the ways to rectify the issues in a stress-free manner.
So read on!
Understanding Your NPI and Tax IDs
Before we dive into more about NPI and Tax ID lookup, let’s first talk about your Tax ID and NPI, their significance, and why you should be extra careful while mentioning these two vital elements anywhere.
National Provider Identifier (NPI):
The NPI number is a 10-digit unique numerical identifier that is issued to every individual as well as organizations providing health care services in the United States. It is provided to them by the Centers for Medicare and Medicaid Services. It has been made mandatory by the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA.
The NPI number is used to identify an individual health care provider or organization. It’s also used by patients and health insurance companies on Medicare and Medicaid claim forms to identify those who provided the medical service. This number is shared with the payers, other organizations, employers, etc.
All the covered health care providers, health plans, and health care clearinghouses are required to have their NPI numbers in the administrative and financial transactions obtained under HIPAA. However, a medical practitioner doesn’t need to have an NPI to practice medicine. Doctors, physicians, and organizations that are non-HIPAA covered or take no third-party fees can easily opt-out of the NPI requirements.
So, if you are a HIPAA covered healthcare provider or supplier who bills federally funded programs for their services, you must have an NPI number associated with your name, address, and license. If you cannot figure out what it is or, due to some reasons, you don’t remember it, don’t worry as you can easily look it up on Google! Similarly, if you are associated with an organization providing health care facilities, you may have an organizational NPI number.
Click here for a quick NPI and tax ID lookup!
Every provider has a Tax Identification Number (TIN). It is a unique nine-digit number used as a tracking number by the United States Internal Revenue Service (IRS), and it is mandatory to mention it on all tax returns filed with the IRS.
The Tax ID of an individual health care provider is their Security Number (SSN). While it is the Employment Identification Number (E-IN) for businesses and organizations. While filing your claim, you must ensure that you are filling up the correct details of your Tax ID.
So, if you are accepted on the panel of an insurance company, they will have your NPI information as well as your Tax ID number stored on file and in-network. This implies that your insurance company will have one of these four combinations stored with them;
- Your SSN + Individual NPI
- Your EIN + Individual NPI
- Your SSN + Group NPI
- Your EIN + Group NPI
However, the combination of SSN + Group NPI is quite rare, so you can assume that your insurance company must be having any one of the remaining three combinations.
Figuring Out Your Tax ID and NPI Information
As a healthcare provider, you would need to apply to several insurance companies, and doing a doctor NPI lookup every single time is time-consuming and frustrating. So we strongly recommended that you use a technique to properly record it in a precise manner to avoid confusion and disparities in the future.
The best way to sort out all of this information in a stress-free way is to make a spreadsheet containing the information about every insurance panel you apply to and ensure to list down the NPI, tax ID, and address you are submitting with your application. In this way, you will have all the data in one place in a crystal clear manner. We also encourage you to use the same information in all your applications to save time, complication and reduce the chances of discrepancies in the application forms.
Nevertheless, if you still end up making some errors while filing your claims, and there is mismatched and incorrect information across the panels you are in contract with, don’t get stressed. It happens, and it is okay. You can still rectify the errors.
“What is the best way to do that?” You must be thinking. Well, as easy as it may sound, just a simple phone call is enough to help you out. Whenever you have a new patient, just contact them and ask about their eligibility and insurance claim benefits.
Then call up your insurance company and confirm that you are in the network, all your information is correct, and that the new patient is eligible for your health care services. If they don’t see your information in their system, try out the other three combinations we discussed until you find the right data. Then record it in your spreadsheet, and you are good to go. In this, you will never, ever face denied claims again. Yes, it is that simple!