Submitting medical insurance claims with the correct tax information is key to getting claims paid correctly. How the provider is set up with the government to pay taxes governs some of the information that is entered on the claim forms.
For example, if the provider has an Employer ID Number (EIN) registered with the government for tax purposes, the provider bills under the EIN. Other providers, who lack EINs, bill under their social security numbers. And in more complicated situations, some providers bill under both EIN and SSN. It’s critical for providers to know what tax info is most appropriate for their practices’ claims.
At Solutions Medical Billing, we worked with a doctor who was billing under his social security number and decided to grow his business by hiring additional employees. He obtained an EIN and reported it to Medicare by completing a new application. Some of his other insurance carriers, however, were never notified of the change and continued to pay his claims under his social security number. This caused a major headache for the doctor and his staff.
When a claim is submitted to Medicare it must be sent with an EIN, but if the secondary insurance carrier has the provider enrolled under his social security number, the claims must be sent with the social security number rather than the EIN. To accommodate that, a practice must have the ability to print or send claims with different information on them – some with the EIN, some with the SSN.
Another example comes into play when we are sending claims for out-of-area providers. For these practices, we have found that some Medicare carriers want nothing printed in box 24J of the CMS 1500 form while others require that the NPI be logged there. We have to be able to send claims both ways to accommodate the payers’ preferences.
We have three different forms to choose from when sending a CMS 1500 form for clearinghouse claims. If a provider bills with their SSN to Medicare and we must leave box 24J (individual NPI) blank, we use one form. If they bill using an EIN/Tax ID but they are a sole proprietor and don’t use a group NPI, we use a different form. If they use an EIN and a group NPI, we use a third form.
The requirements can be confusing, but they’re important to getting our providers paid quickly. By having all of the correct forms available and using them appropriately, medical billers like us can cut down on errors and ensure proper payments.
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