Individual Vs. Group NPI in Illinois

Federal and Illinois laws mandate a national provider number, or NPI, must be provided on all health insurance claim forms. Both individual doctors and group practices must obtain their own unique NPI number. Without NPIs, claims will be automatically denied.

Individual

• In Illinois, individual NPIs refer to providers who are in the health care businesses for themselves. This includes private practice doctors, chiropractors and family health doctors. On health insurance claims, the individual NPI number is always listed as the billing NPI number.

Group

• Group NPIs link to providers who are part of a larger health care organization. Providers who use group NPIs include practices with multiple specialties and practices with more than one rendering doctor on staff. A group NPI number should always be placed on the claim form indicated in the pay-to-provider, or payee, field.

Registering NPIs

• If a provider has not registered an NPI with the Illinois Department of Healthcare and Human Services and the Illinois Department of Human Services and needs to do so, then the provider should register a number as soon as possible. Registering can be done over the Internet. You could also call 217-782-0538 and request an NPI information packet