HealthPartners OP SUD billing - Each staff has its own NPI?

BillingAS 2 years ago in Industry News/Discussion updated by sarah 2 years ago 5

We have been told by HealthPartners that in order for our facility to re-credential with them that each staff member at our outpatient SUD facility has to be credentialed and have their own NPI and that there is no way around this. Each staff member would also have to apply through the HP portal and give all their employment history, DOB, SSN etc. I informed our rep that we bill by the facility under one NPI. She referred me to a section on HealthPartners portal that does say that LADC must be credentialed but I still don't believe this is right. We have been credentialed with them since before my time and all of our HP PMAP and commercial claims continue to get paid even though we are not enrolled this way. Any one else run into this issue? If so how were you able to fix it? 


I have been told this as well and I think it is 100% incorrect. We bill our IOP claims under our organization NPI, never an individual NPI. The only thing I could think of is to credential the Treatment director as ours does have an NPI but most of our other providers don't and their name/NPI would never show up on a claim as we bill as a facility claim. 

If anyone else has a way to get this through to HP, I'm all ears. 

When we recently built our contract, we had to submit a list of credentialed staff (credentialed meaning license credentials, not NPI), but nothing related to NPIs. The NPI billed is the facility NPI, so staff do not need an NPI, not even the tx director.

We contract with HP as a facility for our OP Chem Dep and MH IOP services and although we bill as a facility for both, we have always had to have each our or CD & MH IOP providers credentialed individually with them as well.  We also have to do this with BCBS ND even though we bill as a facility for these services too.  

The Provider Agreement that is referenced in your contract explicitly states which providers need to be credentialed, even if you're billing as a facility. If you are not credentialing your staff per contract requirements, you are essentially in breach of your contract and the agency is at risk for audit. Clinicians can obtain an NPI with very minimal lift. MCC centralizes credentialing. 

We have our facility and all licensed staff credentialed with HP under a facility and individual NPI's.