FAQs: Credentialing

Credentialing can be confusing. We've been getting lots of questions about credentialing as new dietitians are signing up. Today, we're addressing some of the ones we see more frequently.

Should I get an NPI for a new employee?

There are two kinds of NPIs: individual and group.

An individual NPI is always associated with an individual's social security number. A group NPI is associated with a business entity - in this case, your practice's tax id number (sometimes called an EIN). When you hire a new RD, s/he should get an individual NPI if they don't already have one, using the NPPES enumerator. Your practice should already have a group NPI.

Either way, it's a very easy online process Healthy Bytes can help with. It's also a good idea when you hire a new RD, to make sure that the practice is added to the RD's CAQH as a new practice location.

Can he/she use a corporate NPI?

I think what you're asking here is, if an RD is, for example, a sole proprietor and happens to have both an individual NPI and a group NPI for the sole proprietorship - can s/he use her group NPI? If s/he is not yet contracted, you can use either and I'd recommend both. If already contracted, s/he should use the NPI that s/he used when initially contracting with individual insurance companies. In most cases, both should be used and work. Often, an individual NPI is all you'll ever need, but you should always be consistent.  

Can you have a contract RDN bill via your company NPI?

The short answer is, yes. Once the new RD has been added to the practice's roster with each health insurance company- this assumes in some cases that she is already contracted - the practice will start getting paid for claims billed through their group and NPI. In some cases, the RD might have to sign a form called something like a, PRACTITIONER AUTHORIZATION FOR REASSIGNMENT OF BENEFITS TO CLINIC, agreeing to have reimbursements assigned directly to the practice.

How do I know whether I'm credentialed independently vs under my employer?

Once you are contracted, you are contracted. It shouldn't matter if it happened through a group practice or as an individual. The real rub is what assigned Tax ID will receive the reimbursement payments for the claims that are filed. If you were initially contracted through a practice, you'll need to submit a demographic update saying you have a private practice and wish to add an additional tax id number (either your social or EIN) for that practice. If you were initially contracted as an individual, the practice just needs to add you to their roster and you will be good to go.

When RDs or practices contract with health insurance, they are, in essence, agreeing to work as independent contractors and will, therefore, receive 1099s at the end of each year from the various health insurance companies. Having your W-9 information (Tax ID) aligned with your NPI is really important to health insurance companies because they need to report that information to the IRS.