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Q.
I was surfing the Internet to find an answer to a question regarding an NPI and came across your email address. Hopefully you can answer my question. One of the physicians I manage is leaving one group NPI and joining another group NPI. What is the best way to notify the payers of the new group NPI? Any advice you can offer is appreciated.

A.

You have not provided me enough information to give you a definite answer, so I will attempt to go through what needs to be done.

If the practitioner is participating with Medicare in both practices, the current practice reassignment will need to be terminated and a new reassignment will need to be done for the new employer. If the new employer is in a different state and the practitioner has not worked in that state before and currently does not have an enrollment, then a new enrollment will need to be done.

If the practitioner is participating with Medicaid, and not knowing which state, the practitioner will have to be terminated from the current employer and a new enrollment will need to be done for the new employer. Each state’s process is different so it may be a little more complicated than this depending on the state.

All commercial payors will need to be notified that the practitioner is leaving one employer and the credentialing will need to be linked to the new employer tax ID and NPI if the new employer has a group contract. If the new employer only has individual practitioner contracts, then you will need to obtain a new contract for this practitioner and ensure the credentialing is linked to the new employer. If the practitioner is going to a different state, then credentialing will have to be completed all over again, because most payors credential by state.

This is a credentialing and enrollment issue. If you have not performed this type of work before, then it is very important to know what needs to be done, AND to verify that the payors have completed the process because this can result in a lot of denied claims if the entire process is not complete properly. You will need to ensure you have written communication from each payor that the practitioner has been linked to the new tax ID and NPI of the new employer and you have an effective date on when the practitioner may start seeing patients. Until you have this, I would not allow them to see the payor’s members otherwise this may result in lost revenue.



Name: Indiria Jefferies

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