What are the NPI reporting instructions for incorporated individuals?

An incorporated individual is an individual health care provider who has formed a legal entity, such as a corporation or limited liability company, under which he or she conducts business, but which has no other health care providers as part of it. The corporation has an employer identification number, also known as a federal tax identification number, used to identify a business entity.

When billing Blue Cross Blue Shield of Michigan for services, incorporated individuals have previously used one Blue Cross Blue Shield of Michigan provider identification number on claims. In response to the federal government's implementation of NPI, incorporated individuals must obtain two NPIs: a Type 1 (individual) NPI associated with their Social Security number and a Type 2 (organizational) NPI associated with their EIN.

Your Type 1 NPI represents you as an individual and your Type 2 NPI represents your business entity. BCBSM will restructure your enrollment records by establishing a new group record to align with your business Type 2 NPI. Your Type 1 NPI will be aligned with your individual PIN record.

If you are submitting or would like to submit claims electronically, please ensure that you have registered your Type 2 NPI with the Electronic Data Interchange Department. You do not need to register your new group PIN, only your Type 2 NPI.

Other important points to assess in relation to your new group PIN are listed below.

  • Access to Web-DENIS — If you have access to Web-DENIS, or wish to establish access to Web-DENIS, you will need to register your new group PIN by filling out the Authorization for Additional Provider Codes application indicating the user IDs that need access to claims for the new group PIN. The completed form should be faxed to 248-486-2214. This will allow you to view claims in Web-DENIS.
  • Billing — Since your Type 2 NPI is now mapped to a group practice PIN, you will need to submit claims by reporting both a billing NPI (Type 2 NPI) and a rendering NPI (your Type 1 NPI). Please do not report your group PIN or individual license number on your professional electronic claims. We recommend that you submit your electronic claims with NPIs only.
  • EFT — If you are not currently enrolled with EFT, we would like to remind you that as of Oct. 1, 2009, all participating professional providers are required to enroll in EFT. This means you will be receiving your payments and vouchers electronically. Please reference the July 2009 issue of The Record for more information.