NPI Types: A Guide for Private Practice SLPs
You're feeling good- you are on the road to starting a private SLP practice and you have your ducks in a row. You have your EIN and NPI, and you're credentialed with insurance. You get ready to bill for your first insurance session- and see boxes 24J, 33A, and 33B on the CMS 1500 claim form. They all say "NPI" or "Identifier." What does it mean? Do you need to put the same number in each box?
Billing can be confusing, but I can help you figure out what the different types of NPI numbers are and what they mean.
An NPI number is basically an ID number- a National Provider Identifier. It is issued by the CMS (Centers for Medicare and Medicaid Services) to identify individual healthcare providers, and was created as part of HIPAA regulations. It is specific to you, not the job you're in, so it stays the same whether you're in the schools, a medical facility, or a private practice. To check if you have an NPI, visit the NPPES website.
If you are going to be billing insurance - even indirectly by providing a superbill for clients to submit to their insurance company on their own for Out of Network reimbursement- you DO need an NPI. The question remains, which type of NPI do you need?
There are two types of NPI numbers:
Type 1: Individual/Personal NPI
Type 2: Organizational/Group NPI
In general, if you are a solo practitioner, you will just need a Type 1 NPI- UNLESS you have a single-member LLC and plan to accept Medicare. (Confused about business structures? I explain them all in this blog post). In that case, you will also need to apply for a Type 2 NPI for your LLC- even though there is only one of you, an LLC is considered a "group/organization." For example, I have a Type 1 NPI for myself as a provider, Jill Shook, and a Type 2 NPI for my LLC, Jill Shook Therapy.
Applying for a Type 2 NPI is just as simple as applying for a Type 1- go to the NPPES website, sign in, enter your info, and wait the 1-20 days it may take to be approved.
So, now that you have those numbers, what do you do with them? You put them on ALL of your CMS 1500 claim forms and superbills, and they will be your unique identifier with any insurance company you are credentialed with. I have them memorized, but until you do, write them down (I use the Important Business Info page from my Private Practice Foundations Course Handbook).
When you are filling out the CMS 1500 form, your Type 1 (individual) NPI will go in box 24J- "Rendering Provider ID". This is the box for whomever actually rendered (provided) the service being billed.
Your Type 2 NPI will go in box 32A- "Service Facility Location Information", again, IF you have an LLC or other group business structure (partnership, S- or C-corp, etc). This even applies to single-member LLCs. If you are a sole proprietor/solo practitioner and don't have an LLC or other business structure, you'll use your Type 1 NPI. You use your private practice location address for this box, even if you see clients in their homes.
You can choose if you would like to use your Type 1 or Type 2 NPI in Box 33A- "Billing Provider Info"- I use my Type 2 since my private practice, Jill Shook Therapy LLC, is considered an Organization even though I am a single-member LLC. If both of your NPI numbers are on file with the insurance company, you should be fine to use either one as long as you are consistent about which one you use- don't switch from your Type 1 to your Type 2. This box just tells the insurance company who the "pay to" person/organization is, so make sure all of the info is correct so they can get you your money.
If you want even more information, as well as a comparison chart of the business structures and more links to resources for SLPs, check out my step-by-step course, Private Practice Prep Foundations. It has everything you need to start and maintain your private SLP practice, with links, resources, and videos!
So there you go- a crash course in NPIs and how to use them. Have more questions about billing, HIPAA compliance, and setting up your practice? Private Practice Foundations walks you through everything with video modules, links, and handouts. Check it out today!