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Group practice where some clinicians are only out of pocket and others are on panels - how to set up?



1 comment

  • Mariana

    Hi Kathleen, 

    Although we recommend reaching out to your insurance panels to get more information on whether your clinicians can still use your organizational NPI to submit claims once you're removed from the panels, I can provide information regarding what that looks like in our system. The Professional Plan for Groups subscription in SimplePractice is designed for single business entities. We recommend it for group practices that have a group NPI and group tax ID, and each clinician using their individual NPI as their rendering NPI. This means that if your clinicians will be using your group NPI to bill then you can all be in the same account. 

    However, if your clinicians will not be billing with your group NPI, we recommend that they use separate SimplePractice accounts instead of being in the same group account. This is because some payers will require enrollments for claim filing and if you have multiple clinicians using distinct NPIs then only the NPI entered in the enrollment will be able to bill from the account. On the other hand, if each clinician has their own account they can generate their own claim filing enrollments with their NPI and bill successfully. 

    Your SimplePractice account set up group Vs. multiple solo accounts will depend on the information you receive from the payers regarding being removed from their panels and the use of your group NPI. 

    If you would like additional guidance related to your account, please feel free to reach out to us by clicking the blue question mark > Get Help option on the lower right of your SimplePractice account and we'd be glad to work with you.

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