NPI Number Setup Process

1. Add the Doctors Individual NPI number to their Doctor Code - Tables, Doctor Code Table, Maintain Doctor Codes.
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   • If the Individual check box is selected, the claims will be created with the doctors individual information, regardless of what organizational/group practice information is entered elsewhere in the tables.
     
   • This number will print in (and be sent in the electronic equivalent of):
     • the NPI portion of Box 17b of the HCFA form, if the referral source is set to 0 NONE on the Patient Name and Address Information screen and if no referral source is entered on the transaction;
       
     • the NPI portion of Box 24j of the HCFA form;
       
     • box 33a of the HCFA form, if this is a sole practitioner and theres no organizational NPI entered in Change Database Parameters.
   
   
   
2. Add the NPI Number for your Referral Source Codes (if applicable) - Tables, Referral Source Table, Maintain Referral Source Codes.
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   • This number will print in (and be sent in the electronic equivalent of) the NPI portion of Box 17b of the HCFA form, if there is a referral source entered on the Patient Name and Address Information screen and/or if there is a referral source entered on the transaction.

3. 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.
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   • This number will print in (and be sent in the electronic equivalent of) Box 33a of the HCFA form. This number will be overridden by what is entered in the Group NPI Number Table.
   
   
   
4. 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.'
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   • Level 1: If all the doctors in the practice are considered a group when they practice at a specific location:
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     • (1 field in addition to the NPI#)
       
     • Insurance Form = 0 not applicable
       
     • Insurance Carrier = leave blank
       
     • Doctor Code = leave blank
       
     • Location Code = applicable location code
       
     • NPI Number = number assigned to the location for all the doctors
     
     
     
   • Level 2: If all the doctors in the practice are considered a group when they practice at a specific location for patients with any Blue Cross insurance:
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     • (2 fields in addition to the NPI#)
       
     • Insurance Form = G - Blue Cross
       
     • Insurance Carrier = leave blank
       
     • Doctor Code = leave blank
       
     • Location Code = applicable location code
       
     • NPI Number = number assigned by Blue Cross to the location for all the doctors
     
     
     
   • Level 3: If all the doctors in the practice are considered a group when they practice at a specific location for patients with Medicaid insurance:
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     • (3 fields in addition to the NPI#)
       
     • Insurance Form = D - Medicaid
       
     • Insurance Carrier = applicable insurance carrier code
       
     • Doctor Code = leave blank
       
     • Location Code = applicable location code
       
     • NPI Number = number assigned by Medicaid to the location for all the doctors
     
     
     
   • Level 4: If Medicaid has issued a specific Group NPI when any of 3 specific doctors practice at a specific location (out of the 7 total doctors in the practice):
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     • (4 fields in addition to the NPI#)
       
     • Insurance Form = D - Medicaid
       
     • Insurance Carrier = applicable insurance carrier code
       
     • Doctor Code = applicable doctor code (repeat this process for each applicable doctor code)
       
     • Location Code = applicable location code
       
     • NPI Number = number assigned by Medicaid to the location for the doctor
     
     
   • This number will print in (and be sent in the electronic equivalent of) Box 33a of the HCFA form. This number will override what is entered in the Organizational NPI number field in Change Database Parameters.
   
   
   
5. 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.
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   • This number will print in (and be sent in the electronic equivalent of) Box32a of the HCFA form.

6. Select to print the new NPI CMS Form - System, Database Maintenance Menu, CGM webPRACTICE Integration Options.
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   • Select the Use NPI CMS Form check box for your HCFA forms.
     
   • Select the Use NPI UB Form check box if you submit claims on UB-04 forms.
   
   
7. Select to send only the NPI numbers on electronic claims - System, Database Maintenance Menu, Electronic Claims Integration.
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   • Select the Include NPI Numbers in Claims check box for each Insurance Form Number that you send electronic claims to.
     
   • Select the Suppress Legacy Numbers check box for each Insurance Form Number that you send electronic claims to.