Solo Incorporated Practitioners May Have to Reenroll in Medicare

Changes in the Medicare enrollment process over the years have caused some differences between the National Provider Identifier (NPI) and the Medicare identification number assignment process. This may require some physicians to complete a new Medicare enrollment form so their NPI and Medicare "provider types" match. (If Texas Medicare Administrative Contractor (MAC) TrailBlazer Health Enterprises can't match up your Medicare enrollment records with the NPI enumerator's records, TrailBlazer will reject your Medicare claims.)

Particularly affected are solo incorporated practices. Solo incorporated practices are required to obtain both an organizational NPI and an individual NPI. If you have two NPIs but only one Medicare provider number, a new CMS 855 application may be necessary. To find form CMS 855 on the CMS Forms Web page, sort by "Show only items containing the following word [855]."

Confused about the need for two NPIs? Read " Incorporated Physicians, Group Practices May Need Multiple Identifiersmembers only final  in the January 2007 Texas Medicine .

Learn more about the NPI on TMA's NPI Resource Center .


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