Understanding NPI and Legacy Numbers in Healthcare Billing
Last update :
legacy number and upin number - no need to print - individual and organization NPI is enough.
Effective May 23, 2008
Only an NPI may be entered in any provider identifier fields on claims submitted on or after May 23, 2008. Claims will be rejected when submitted with a Medicare legacy number (PIN/PTAN) or a UPIN in any provider identifying field on or after May 23, 2008.
Type 1 is an individual NPI. Type 2 is an organizational NPI.
Incorporated Individual with individual legacy number and individual NPI: 24J – Enter nothing 33a – Enter type 1 Individual NPI
Incorporated Individual with individual legacy, group legacy, individual NPI and group NPI: 24J – Enter type 1 Individual NPI 33a – Enter type 2 Corporation NPI
Sole Proprietor, not billing for an employee: 24J – Enter nothing 33a – Enter type 1 Individual NPI
Sole Proprietor, billing for an employee: 24J – Enter type 1 Employee individual NPI 33a – Enter type 1 Individual NPI in
Clinics and multiple group offices: 24J – Enter type 1 Individual NPI 33a – Enter type 2 Group NPI
Organizations/Facilities (e.g. ASC, Ambulance, IDTF, etc.): 24J – Enter nothing 33a – Enter type 2 Facility NPI
Provider set up as a group (individual and group legacy) and only one NPI: Contact Provider Enrollment: (888) 608-8816 [Select Option 1]