The employee table contains information specific to an employee. For employees that are also Providers, additional information is required to register the employee as a Provider and allow a Provider to bill claims for his/her services. The employee module captures the required CMS-1500 information related to the Provider (see CMS-1500 and HIPAA regulation and rules for more information).
The following screen allows you to enter the Provider required CMS information which will be used in claim creation.
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The National Provider Identifier (NPI) is a 10-digit nationally assigned standard Identifier that will replace payer-specific identifiers for all healthcare providers no later than May 23, 2007. Individual healthcare providers are eligible for a single Type 1 Individual NPI. Healthcare organizations are eligible for a Type 2 Organization NPI.
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Group Practices are also eligible to obtain a Type 2 Organization NPI. HIPAA is mandating enrollment of Group Practices in order to maintain group affiliations with the individual practitioners. This is required so that the payor can identify situations where individual providers belong to more than one group, or where providers have their own practice as well as belonging to a group, and determine where to send payments in these situations.
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Healthcare organizations may also decide to subpart, or obtain multiple NPIs, based on location, unit, department, certification, licensure, or other billing and payment needs. How an organization subparts may impact how they bill, where payments are sent, and if they need to include taxonomy codes on their claim submissions.
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Although an NPI may correspond to several different service locations, The Payor will only send payments for a single NPI to one Provider Name, one Payment Address, one Remittance Advice Address, one EFT Account Number, one Federal EIN (or SSN) for Tax/1099 purposes, and one Service Center/Receiver for electronic transactions outbound to the Provider.
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Insurance Provider Numbers (other than NPI) (Only Available in US version)
As of May 23, 2007 the NPI has replaced the PIN and Group numbers. If you require legacy numbers they are located under the Insurance Provider Numbers (other than NPI) tab. Check with the insurance plan to see if any are required. If they are not required for that specific insurance plan then remove any entry related to that plan. If legacy numbers are entered and should not be, they will be used and your claim will be rejected.
