Office Therapy - Errors Related to Billing NPI - Loop 2010AA
Reference Number: AA-00292 Views: 49556 Created: 03-14-2012 02:10 pm Last Updated: 06-28-2018 03:47 pm 0 Rating/ Voters

Possible Rejection Messages

  • Billing provider NPI cannot be repeated in rendering loops
  • Billing provider NPI is required must be valid for this payer

There are two types of NPI's

  1. Type 1 NPI (Individual) - is defined as an individual who renders healthcare services including sole providers. These are usually applied for using the Providers SSN.
  2. Type 2 NPI (Organization) - is defined as an organization providing health care services, such as group practices, professional corporations, and clinics, including incorporated individuals. These are usually applied for using the organization's Employer Identification Number (EIN).

Most sole proprietorship providers will have only one NPI and that is the Type 1 Individual NPI. In a group setup, there will be a Type 2 Organizational NPI for the group and a Type 1 Individual NPI for each provider. However, an incorporated individual could have a Type 1 Individual NPI for themselves and Type 2 Organization NPI for their corporation. 

Most of NPI related rejections occur because the NPI that is being entered in the program thus sent out on the claim is not the one that is setup at the payer for billing. 

So what matters is, 
How are you setup with the payer for billing - as an individual or as a group?

Your first step in reducing NPI related rejections is to review your paperwork or contact your payer to find out what NPI you have setup with them.

If you are setup with the payer as an individual

  1. When setting up the Provider in Office Therapy, under Provider Setup on the Provider Demographics tab, enter the providers Individual Type 1 NPI in the NPI box.
  2. Next on the HCFA Details tab, to setup billing preferences for the payer, click the Add button. Then on the Insurance Specific Provider Settings, pick the insurance company that you want to enter these settings for. Next choose all the radio buttons under the "Use Provider Info" column. Doing so will sent the providers name, providers address, his individual NPI and his Tax ID information all of which is entered on the Provider Demographics tab.
Note: On the Insurance Specific Provider Settings

  • If you want to enter a Pay To address that is difference than your Address setup under Provider Demographics. Ex. You want your checks to go to a PO Box instead of a street address, select the check "Use Custom" radio button under Pay To Address and enter your address information in the corresponding fields.
  • If you are setup with all your payers as an individual and have the exact same settings, choose "All" option instead of picking an individual insurance company.

 If you are setup with the payer as a group

  1. Setup all your company information under File > Maintain Company Information. Enter the providers Organizational Type 2 NPI in the Organization NPI Box.
  2. Next set up the Provider in Office Therapy, under Provider Setup on the Provider Demographics tab, enter the providers Individual Type 1 NPI in the NPI box. Even if you are setup with a payer as a group you still need to setup the individual NPI information because it is required on the claim in the Rendering Provider Loop.

  3. Next on the HCFA Details tab, to setup billing preferences for the payer, click the Add button. Then on the Insurance Specific Provider Settings, pick the insurance company that you want to enter these settings for. Next choose all the radio buttons under the "Use Company Info" column. Doing so will send the company/group name, company/group address, organizational NPI and the company tax information all of which is entered on the Company Information screen. 

Note: On the Insurance Specific Provider Settings

  • If you want to enter a Pay To Address that is different than the Address setup under Company Information. Ex. You want your checks to go to a PO Box instead of a street address for your group, select the check "Use Custom" radio button under Pay To Address and enter your address information in the corresponding fields. 
  • If you are setup with all your payers as a group and have the exact same setting, choose the "All" option instead of picking an individual insurance company.

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