Medicare Denials for NPI Crosswalk

Posted by KUNAL JAIN on Nov 12 2008

Fotolia_42154735_Subscription_Monthly_MQuestion: Solo physicians should submit the claims under individual NPI or They have to apply for a group NPI?

Answer: This question has been raised several times since the NPI crossover was implemented and our experience with this is as follows: Medicare asks new physicians or practices who apply for medicare not to have separate NPI for their corporation even if they are solo. Once they apply for a separate NPI, Medicare assigns them 2 PTAN which are associated with group and individual NPI's respectively. Practice management software should have a capability to populate the right PTAN in box 33 and 24 on CMS 1500 form in order to get the claims accepted with Medicare.





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Topics: Medicare, Medicare Denials

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