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Are you a sole proprietor? You may need a Type 2 NPI.

September 19, 2011

All individual professional providers who either conduct business using HIPAA-standard transactions themselves or have business conducted on their behalf by an employer, are required to obtain a Type 1 National Provider Identifier (NPI). In the latter case, this Type 1 NPI is used to identify the professional that rendered the service being billed on the claim. 

If you are a sole proprietor wishing to incorporate your practice as an organization, you will need to complete the following steps (after you have taken the legal steps to create your organization):

  1. Obtain a Type 2 NPI Organizational NPI – Apply online by going to the National Plan and Provider Enumeration System (NPPES) website  .
  2. Request a new Provider Record ID packet from Blue Cross and Blue Shield of Texas (BCBSTX). You will need to notify BCBSTX once you have received your new Type 2 NPI from NPPES. Visit our provider website and click Network Participation, How to Join and then click Request a BCBSTX Provider Record ID. Complete the Group Provider Record ID Information Form Packet.
  3. Submit your completed packet to BCBSTX – Specify that your new Type 2 NPI should be designated as your billing NPI in the BCBSTX system, with your Type 1 NPI designated as your rendering NPI. Be sure you have notified Medicare as well, or there may be issues processing crossover claims.

Following the above steps will help ensure that the correct information is on file with BCBSTX so that your claims may be processed and paid accordingly.