Using Both EIN and SS Numbers For Medical Claims Submissions As a Tax Identifier

We often run into providers who are having seriousname. The provider keeps the individual or Type I
issues with their medical insurance billing that all stemNPI to identify themselves as the rendering provider
back to billing under both an EIN# and their socialbut uses the Type II NPI for billing purposes. An
security # as identifying tax information. Most peopleindividual or Type I NPI cannot be used with an EIN#
think it's not a big deal, and how messed up can itand a legal business name.
get. But you would be amazed at how much aWhen billing insurance claims the correct information
providers income can be affected by the billing notmust appear in the correct locations. For example,
being submitted correctly regarding the tax ID# thatthe individual NPI must be in the rendering physician
is submitted to the insurance carriers. With NPIbox (24J on the CMS form) and the type II or group
numbers now in the picture, the confusion has grown.NPI must be in the provider billing information (33A on
It was very common for a provider to have begunthe CMS form). The EIN# must be in box 25 on the
their practice years ago and to have started outCMS form with the EIN box checked. But just having
billing under their social security number. Many did thisthe information in the right boxes does not ensure
because it was just easier. They figured they couldclaims will be processed that way. The insurance
switch over to an EIN# number later on, when theircarriers must also have this information on their
practice was bigger. The problem is that switchingprovider files this way as well.
from a social security number to an EIN number isWe have had many providers who have switched
not a simple task and it usually freaks yourfrom their social security number to an EIN# number
accountant out. Actually, the problem is that thesomewhere along the line and cannot figure out why
accountant doesn't understand that it is a problemthe are not getting payments. Many times when we
with the insurance carriers and they switch themlook into the problem we find that they are billing
over without advising them. The accountant tells theunder their tax EIN# but they are enrolled with the
provider it's no big deal to switch, when it is.insurance carrier under their social security number.
When a provider changes any information regardingWhen claims are submitted under the EIN# they are
their practice they must notify all insurance carrierseither processed out of network or denied. So if you
using the required method of each insurance carrier.have a provider who is receiving a lot of unexplained
When changing tax ID information, many commercialdenials, or claims are being processed out of network
carriers require that new contracts be signed. Evenwhen they are participating, you may want to see if
though the provider may have been in network withthey have switched to a tax ID number recently.
an insurance carrier for years, when switching to anThat may be the whole problem. Whether billing
EIN# it is as if it is an entirely new provider. Medicareunder a social security number or a tax ID/EIN
requires that the appropriate CMS forms benumber, it is important to make sure you are billing
completed. In any case, the switch must be reportedthe way it is set up in the insurance carrier's system
using the appropriate format.or you can experience major problems with your
In addition to switching to a EIN#, the provider mustinsurance claims causing your accounts receivable to
also obtain a group, or Type II NPI number toget out of control.
correspond with the tax ID number and business