When Enrolling Your Group With Payors, It’s How You Establish Yourself That Counts

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When a provider, healthcare group, hospital or entity is first establishing itself with payors, it’s important to know that to receive reimbursements, all of the information must align with and flows from the identifiers you provide on the application.

Your organization’s legal entity name is one of the primary identifiers. Unless all the information matches up with your legal entity name, your organization could risk running into compliance issues, as well as potentially losing reimbursements from payors.

Your group’s legal name is the way it will be identified when enrolling with payors. This name is the way your business was chartered, filed, registered or otherwise legally declared. You should use the name exactly as the organization is established with the Internal Revenue Service (IRS).

Since you don’t want to take chances on making a mistake when beginning the enrollment process, it’s essential that attention is paid when entering the required identification information. This starts with using your legal name, which oftentimes is not necessarily the same as your DBA. Although your group may use the legal name as the DBA, quite often the group goes by another name. Your legal name is what you will always use for establishing yourself with payors.

About Your Federal Tax ID Number

This number is your group’s Employer Identification Number (EIN), also known as Tax ID Number (TIN), which is assigned to a legal entity by the IRS.

The name you use to register your organization’s tax ID must match the legal entity name by which your business is registered, as in your articles of incorporation or organization. If these do not match, you will have to go through the process of either updating your legal name or the name by which you registered your Tax ID with the IRS. Either way, you are looking at a loss of time, which equals a loss of revenue. Be sure to set up your business correctly the first time.

The Importance of the NPI Number

Your group’s NPI, or National Provider Identifier, is the number issued to the legal entity by the National Plan and Provider Enumeration System (NPPES). You must apply for an NPI number for your legal entity if filing claims under that name and Tax ID. The NPI number is used along with your group’s legal entity name and TIN as an identification marker.

You do not have to apply for multiple group NPI numbers; however; if your group provides services in multiple states, it is often easier to reconcile payments if you have a group NPI per state. Unless you set up different NPI numbers for states/regions, the payor’s system can randomly draw from the fee schedule from the place/state where the original contract was established instead of the actual place of service. Sharing an NPI across states can cause confusion because fee schedules are not the same in each state. This can also lead to overpayments or underpayments. Either situation will cause problems down the line if you are ever audited.

Not only does your business legal name matter, but also your legal name

Many people have one name that appears on their birth certificate and another they like to use or go by every day. This makes a huge difference when filling out any applications or paperwork.

For enrollment, you must go by the legal name that matches the name on your social security card. This is the name you need to use when applying for your license, DEA (Drug Enforcement Agency) number, NPI, etc. It is fine if you have a different name on the office door or signage, but it is not legally acceptable with the payors.

This guideline also applies to how you sign your name. The signed name must match the legal name on the application. If your name is William Smith, don’t fill out applications and sign as Bob Smith. This issue comes up quite frequently with providers born outside of the United States in whose native countries, the name may be changed for reasons including marital status or gender. These providers may also “Americanize” their names. These changes pose no problem as long as the proper legal name is used for enrollment and signatures.

Your name must also match on all documents. From your social security card to your driver’s license to your medical license, the name must be the same on all. This also applies to female providers who may change their legal name when getting married or divorced. All of these changes must be reported to the payors with which you are enrolled. The payors will want you to update your records with them as soon as possible, and most likely will request a copy of the document showing why and when your name was changed. Although this may seem trivial, if your name is not updated in the payor’s records, the discrepancy can eventually affect cash flow.

If you follow these simple steps during enrollment, your group and individual providers will be on the way to timely processing of applications and quicker reimbursements by payors! Knowledge such as this is another reason to reach out to experts when enrolling your providers. At symplr, we know the intricacies of the process and are ready to help you.

 

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We offer complete client support to help you navigate the complexity of provider enrollment, saving you time and money. Learn more about Payor Enrollment Services at www.symplr.com/products/payor-enrollment-servicesor schedule a demo at [email protected].


Aubrey Darr

About the Author
Aubrey Darr

At symplr, Aubrey is a Payor Enrollment Specialist with extensive knowledge in provider enrollment and credentialing. Her understanding of credentialing processes and requirements greatly enhances her ability to streamline the enrollment process, ensuring that providers are enrolled with health plans correctly and efficiently. Her previous experience includes supervisory experience in enrollment services in both large and small healthcare organizations. Aubrey has over 10 years’ experience in provider enrollment and credentialing, working in multiple states and with all specialty types.

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