Around this time every year, Holistic Billing gets swamped with calls from newly minted healthcare providers. On these calls, an all-too-frequent question is "what is necessary for accepting insurance?". Here's the quick answer, whether fresh-out-of-school or looking to add insurance to an existing practice, the first thing you need to do to participate with insurers is applying for your NPI.
Healthcare providers in the United States are required to have a government-issued identification number to bill insurance. To apply, you fill out an online application, and the NPI is then issued to you in a couple of days via email.
Why do I need the NPI?
To be paid by any insurance company, your NPI is used on claims as a form of identification.
Where do I apply for my NPI?
You'll want to go to the National Plan and Provider Enumeration System (NPPES) and apply for your unique identifier.
But, Medicare doesn’t pay for acupuncture or massage therapy, is the NPI for Medicare claims only?
No, the NPI is your identifier for all health insurance plans, whether Medicare pays for your services or not.
I am a solo practitioner but have incorporated my practice. Do I need both the individual NPI and an NPI for the practice?
Yes, in this case, both the practice and the individual practitioner should each have an NPI. Your state license number should appear on the individual application. Then, the organizational application should include your tax identification number. It is not necessary to include your state license number on the application for the organizational NPI. You apply for each NPI separately, and you will be asked to create a profile for each type of application on the NPPES website.
Where can I get more help and information about the NPI?
Visit the CMS Web site for more information. The site has a great selection of frequently asked questions. Also, you may call NPPES directly at 1-800-465-3203.