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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Physician Credentialing

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 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 payors 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 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 your NPI application’s accuracy! To minimize rejections from credentialing entities and reduce your claim denials, it’s imperative that your 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.

Online Training For Physician Credentialing

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Master NPPES Compliance to Avoid Penalties and Get Paid Faster
PECOS: Master CMS Surrogacy Enrollment Requirements
CAQH Credentialing Portal Made Easier and Less Time Consuming

Meet Your Writer

Jen Godreau

Content Director

Jen Godreau, CPC, CPMA, CPEDC, COPC, AHIMA ICD-10-CM/PCS Approved Trainer is an expert in practice management, billing and coding, and revenue cycle management, and brings almost 20 years of experience to the content team at Training Leader. Prior to joining Training Leader, Jen led implementations of EMRs and revenue cycle management services including credentialing. She has led teams who have created numerous software programs and tools for compliance, coding, and auditing. Her passion for all things compliance and coding has filled thousands of articles and allowed her to provide practice management consulting and due diligence for hundreds of practices.

Jen's advocacy led to the overturning of neonatology supervision restrictions, creation of new CPT ENT codes, and winning of Medicare monitoring auditing contracts. She wrote the diagnosis study guide for AAPC's Certified Otolaryngology Coder (CENTC) exam and edited the AAPC Professional Medical Coding Curriculum.

Jen has a Bachelor of Arts from Wittenberg University in Springfield, Ohio. She became a Certified Professional Coder (CPC) in 2001, added her designation as a Certified Pediatric Coder (CPEDC) in 2009, became a Certified Medical Coding Auditor (CPMA) in 2010, and a Certified Ophthalmology Professional Coder (COPC) in 2017. She is an AHIMA ICD-10-CM/PCS approved trainer.