Physician Credentialing: Prevent Cash Flow Break with NPI Accuracy Essentials

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Physician Credentialing: Prevent Cash Flow Break with NPI Accuracy Essentials

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Make no mistake! Setting up and maintaining the accuracy of each of your physician’s National Provider Identifier (NPI) is essential and COMPLEX. Any error on your NPI application will result in your reimbursement being delayed and a hit to your practice’s cash flow.

As a Medicaid/Medicare provider, you are required to obtain a NPI to get paid from CMS contractors. Many private payers also require an NPI number to get paid. There are two ways to register:

  1. Web-based National Plan & Provider Enumeration System (NPPES)
  2. Paper NPI application, or through an Electronic File Interchange Organization (EFIO).

Get advice from a credentialing expert to sidestep blunders and get paid faster.

Accurate NPI Application Yields Paid Claims

CMS is very particular about the accuracy of your NPI application! To minimize rejections from credentialing entities and reduce your claim denials, it’s imperative that your NPI application is accurate and complete  – the first time. When completing your application online with NPPES, use these tips to make it easier and improve your outcomes.

  • Begin with an I&A. To use the NPPES online application, you first need to create an Identity & Access Management System (I&A) user ID and password. For more information on how to do this, sing up for the online training “PECOS: Master CMS Surrogacy Enrollment Requirements.”
  • Be careful entering data. You have a lot of numbers to manage when applying for an NPI number! It is extremely important that you double, and triple, check the accuracy of the put SSN, ITIN, and EIN numbers you enter, and ensure you are putting them in the correct fields.
  • Don’t rush. You don’t have to complete your application in one sitting. The NPPES system allows you to save a partially completed application and then return to finish and submit it late
  • Use specific geographic location. Even if you utilize a PO box for your primary mailing address, it’s important to input your physical practice street address in the physical location field. Your application will be kicked back if you input a PO box or Commercial Mail Receiving Agency (CMRA) into this field.
  • Adhere to multiple locations extra steps. You can enter multiple practice locations and taxonomies, but keep in mind you only need one, and make sure you identify one as your primary.
  • Get your taxation numbers straight. Healthcare providers who are individuals can use either their SSN or ITIN, where as organizations are only allowed to use their EIN.
  • Don’t forget your state. Be sure to list the state that assigned your Medicaid number if you enter your Medicaid number as an identifier in the Other Identification Numbers section.
  • Keep Records. After you complete your application, print the confirmation page for your records. This will act as your record should anything go wrong.  And if you do have to reenter any data, it will make your life a lot easier.

Source: National Plan & Provider Enumeration System

Get NPPES Expert Guidance

Keeping your NPPES data current is a lot of work—and your practice’s financial health relies on it. The good news is that nationally certified credentialing specialist, Yesenia Servin, CPMSM, PESC can help! During her online training session, Yesenia will walk you through how to successfully maintain, and navigate through your NPPES profile—whether you have just one or multiple accounts.


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Meet Your Writer

Jen Godreau
CPC, CPMA, CPEDC, COPC

Content Director

Jennifer Godreau, CPC, CPMA, CPEDC, COPC, has almost 20 years of experience in billing, coding, compliance, and practice management. She develops the content and programs for Healthcare Training Leader, a practice-specific online training company offering step-by-step advice on increasing reimbursement and avoiding compliance violations. Prior to joining Healthcare Training Leader, Jennifer supervised the program delivery for EMRs, practice management systems and compliance and revenue cycle services for more than 6,000 providers. Thousands of software products - encoders, claims management, auditing, and HIPAA compliance, have been created with her teams and helped thousands of practices more easily reduce revenue losses and comply with complex regulations. Her passion for breaking down healthcare rules and requirements in simple steps has provided practical advice, education, and risk reduction strategies to numerous associations, payers and medical specialties especially in primary care, otolaryngology, eye care, and pediatrics. Jennifer’s advocacy resulted in supervision rule revisions, new CPT codes, and CMS compliance contracts. She oversaw the provider auditing and education for one of the major corporate integrity health system settlements. Jennifer has authored and presented on numerous healthcare compliance and payment challenges. Her education guides include the Certified Otolaryngology Coder (CENTC) exam study guide and the AAPC Professional Medical Coding Curriculum. Jennifer has a Bachelor of Arts from Wittenberg University in Springfield, Ohio. She holds certificates in coding, auditing, pediatric coding, and ophthalmology billing and coding, and is AAPC Vice President of the Naples, FL chapter. Please reach out to Jennifer for step-by-step guidance at editorial@hctrainingleader.com