National provider identification (NPI) numbers are standard, unique identifiers for healthcare providers and health plans. The Administrative Simplification Mandate of HIPAA made NPIs mandatory for almost all clinicians.
NPIs play an important role in the claims process. They identify the person providing services and any group they may belong to, and they are also used to identify payers. Having the correct NPI information is critical when submitting insurance claims – claims may be rejected if the information submitted does not match the information that is on file with the payer, which can hinder your ability to get paid for the services rendered.
What is the difference between a Type I and Type II NPI?
Type I
- A Type I, or rendering, NPI is associated with an individual and used on claims to identify the specific provider of a service. This, combined with a taxonomy code, allows you to identify services within your scope of practice and for which of these services you should be reimbursed by a payer.
- In TherapyNotes, your Type I NPI is recorded in your Profile. Your Type I NPI is automatically included on claims for the services you provide. In the case of supervision, the supervised clinician may bill using the supervisor's credentials, including their Type I NPI. To learn more, read Set Up Supervision.
Type II
- A Type II, or organizational, NPI is associated with a group, practice, or other entity. Obtaining a Type II NPI allows your entire practice to credential with a payer simultaneously. When credentialed as a group, every provider in your practice is able to bill to the payer.
- In TherapyNotes, your Type II NPI is recorded in your Practice Information and Locations Settings (Settings > Practice Information and Locations) and will be included on all claims submitted by your practice. This information will also be automatically entered on the appropriate documents when enrolling to submit electronic claims. Clinicians may bill using a Type II NPI that differs from the practice's Type II NPI or bill using the practice as the rendering provider by setting up a clinician billing setting override.
- Verify that both your Type I and Type II NPIs are accurate and match the information on file with your payers. Mismatching information may lead to claim rejections or denied enrollment paperwork.
How do I obtain an NPI?
- You can register for both Type I and Type II NPIs through the National Plan & Provider Enumeration System. You can also search the NPPES NPI Registry to find established NPIs.