How to Bill a Claim With NPI
National Provider Identification (NPI) is a 10-digit number provided to healthcare providers under the Health Insurance Portability Accountability Act (HIPAA). The NPI is an identification number and replaces legacy provider numbers and tax IDs. Generally required for billing purposes, all healthcare providers and facilities are required to share this identification with other providers. The NPI rule was established in January 2004, and upon its implementation, the Health Insurance Claim Form (HCFA 1500) was modified to include fields for referring providers and rendering suppliers and providers.
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Instructions
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Locate the NPI number of the healthcare provider who referred the patient. You can find this by contacting the provider's office or searching the NPI Registry.
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Record the referring provider's NPI in box 17b of the HCFA form. If your billing software is capable of saving this information, it is best to save it so you do not have to retype the NPI for additional patients. Most billing software contains databases for storing this information.
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Locate the NPI number of the rendering supplier or provider. A provider is typically a physician, while a supplier may include a durable medical equipment company. Store this information in your billing software to avoid duplicate research.
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Insert the rendering supplier or provider's NPI in box 24j. For each line of service you bill in box 24, the NPI number is needed in box j. For instance, if you bill an item on lines 1, 2 and 3, the NPI needs to appear in box j on lines 1, 2 and 3.
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Enter the billing provider's NPI in box 33b. The rendering provider is usually the billing provider.
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Submit the claim electronically, or print and mail the claim to the insurance company.
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Tips & Warnings
When searching for providers on the NPI registry, an "Individual Provider" is a person, while an "Organizational Provider" can be a company or facility.
