We bill out for 2 MD's and 2 Nurse Practitioner's under one of our MD's billing NPI. We are a pediatrics office and are not specialist but almost all of our claims are coming back processed as specialty copays/prices. The provider who sees the patient has their NPI on the line items and the billing is all under one MD. Can someone tell me what I'm doing wrong? It seems like the last 3 times we have hired new providers we have so many issues with credentialing and rejected claims. Thank you!
Hello, it sounds like it may be the Taxonomy numbers associated with the provider's contracts. There are a few different things to verify. Start by looking up your provider's NPI number by going to NPPES, looking up the NPI you are using on claims, either group or individual, there you can see the primary Taxonomy associated with the NPI. Next, verify the provider's contracts to see what they put on the contract. That is a more likely place as they may have additional Taxonomies associated with their contracts. If the Taxonomies are incorrect contact your provider relations to get it corrected, or bill accordingly.
If they are correct, contact provider relations to see what they are showing. If this is not the issue, ask provider relations to verify if they are marking your providers as a specialist, or have them verify their credentialling.
Here are a few links to get you started
Healthcare provider Taxonomy 2022
NPPES NPI look-up tool.