NPI Number Setup Process

As of May 23, 2008 it was required that only NPI numbers (no Legacy numbers) be submitted on all claims.

The following steps should be performed to set up your NPI numbers in CGM webPRACTICE.

Setup Steps

  1. Add the Doctors Individual NPI number to their Doctor Code - Tables, Doctor Code Table, Maintain Doctor Codes.

  2. Add the NPI Number for your Referral Source Codes (if applicable) - Tables, Referral Source Table, Maintain Referral Source Codes.

The following steps depend upon the structure of your practice and how you applied for your NPI numbers. Since you can have different Organizational or Group NPI numbers for different locations, you should only perform the steps that apply to your individual situation:

  1. Add the Organizational NPI Number - System, Database Maintenance Menu, Change Database Parameters, if your practice only has one Organizational NPI number. Typically, if the locations your doctors practice at all use the same Tax ID, then there is typically just one Organizational NPI. Similarly, you would probably then only have one group number assigned by Medicare. You would end up having 2 different NPI numbers in the electronic claim file or on the HCFA form - one for the doctor and one for the organization.

  2. Add the Group NPI Number to the Group NPI Number Table - Tables, Doctor Code Table, Provider Number Table, Group NPI Number Table, Maintain Group NPI Numbers. For example, Dr. Jones belongs to two separate groups and practices at two separate locations. Each group may or may not have a separate Tax ID number, it does not matter which. When he practices at location 1, he uses his individual NPI number and he uses the Group NPI number for location 1. When he practices at location 2, he still uses his individual NPI number and he uses the Group NPI number for location 2. You would end up having 2 different NPI numbers in the electronic claim file or on the new CMS (HCFA) form - one for the doctor and one for the group.

    When you create insurance claims, CGM webPRACTICE will determine which NPI # to report based on the highest level of data (number of fields) completed in the table. The samples provided below are just a few of a wide variety of scenarios that could occur at each level. The general guideline that CGM webPRACTICE uses to determine the level of data is 'the quantity of fields that have been completed in addition to the NPI Number field.'

  3. Add the Location NPI Number - Tables, Location Code Table, Maintain Location Codes. For example, Dr. Jones from the sample above, joins a third group that practices at location 3. The same process from the above example would apply when he practices at location 3, he would use his individual NPI number and the Group NPI number for location 3. In addition, say location 3 applied for a separate NPI number that is different from the Group NPI for location 3. In this case, the separate NPI number for location 3 would need to be submitted in addition to the Group NPI for location 3. You would end up having 3 different NPI numbers in the electronic claim file or on the new CMS (HCFA) form - one for the doctor, one for the group, and one for the location.

You should perform the following only after completing the previous steps:

  1. Select to print the new NPI CMS Form - System, Database Maintenance Menu, CGM webPRACTICE Integration Options.
  2. Select to send only the NPI numbers on electronic claims - System, Database Maintenance Menu, Electronic Claims Integration.

Refer to the National NPI Search Engine for additional information.