NPI Updates
Aug 23, 2016Do you know when to report changes to the NPI Enumerator?
Most third-parties utilize the NPI electronic database to verify the identity of a provider and/or billing entity. It is important that the NPI information be current to avoid any claims processing delays. If the current information for the treating and/or prescribing provider in the NPI database does not match the payers’ information or the information reported on the claim form, you may experience a delay in claims processing. All changes must be reported to the NPI Enumerator within 30 days of the effective date of the change. This applies to both providers and billing entities with NPI type 1 and/or NPI type 2 numbers.
Type 1 NPI: Identifies an individual healthcare provider, such as a physician or dentist. It is used to identify the treating doctor listed on the dental claim form.
Type 2 NPI: Identifies an organization or billing entity, such as a dental clinic, practice, corporation, hospital, or dental school. An organization might be a partnership, sole proprietorship, or LLC. HIPAA does not require that the organization be incorporated.
Reportable changes may include, but are not limited to, the following:
- Individual name.
- Organization legal business name or other name, such as a DBA (Doing Business As).
- EIN (Employer Identification Number).
- Business mailing address.
- Practice location address.
- The addition or deletion of other identification numbers, including Medicare and Medicaid identification numbers.
- The addition or deletion of provider taxonomy codes.
Complete a National Provider Identifier (NPI) application/update form (CMS- 10114) to report updates to NPI numbers and payer information. The form may be completed online or by submitting a paper form. You can complete the form online or download a paper copy on the National Plan and Provider Enumeration System (NPPES) website at https://nppes.cms.hhs.gov.
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