Therapist reviews: Headway vs Grow Therapy
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Learn how to apply for an NPI number with our step-by-step guide tailored for mental health providers.
Establishing a National Provider Identifier (NPI) number is a foundational requirement for starting your own private practice and practicing therapy. An NPI is also required to bill insurance companies, whether in private practice or part of another group practice. This unique identifier follows you throughout your career as a mental health provider just as a social security number serves as an identifier for individuals. An individual NPI allows you to practice, bill for services, and conduct any transactions involving client data that would be governed by HIPAA law. For those starting their own private or group practice, an Organization NPI needs to be established. Setting up an NPI is a simple but specific process that is a necessity in order to offer therapy services.
The NPI is a 10-digit unique identifier that is assigned to healthcare providers and organizations. Type 1 NPI applications are for individual mental health providers to be able to practice and bill for services. This includes practicing independently or as a part of an organization. If you work for a group practice or hospital, you will still need your own individual NPI.
Type 2 NPI applications are for organizations, such as a group practice. The identifier stays with the provider or organization for their lifespan and never changes. Applications and NPI numbers are administered through the National Plan and Provider Enumeration System (NPPES) website. (Headway doesn’t use type 2 NPIs for credentialing — only type 1.)
The main purpose of these numbers is to identify the providers that are facilitating all administrative and financial transactions that involve the transfer of client data. These transactions are governed by HIPAA law. The primary use of the NPI is for billing and filing claims with insurance. Almost all insurance companies require an NPI for billing, making it essential for any therapists who bill insurance for services. Situations where an NPI is often required include credentialing, billing submission, checking claim status, setting up payouts, obtaining liability insurance and facilitating referrals and authorizations.
If you are credentialing with insurance, you will need a CAQH profile, which will require an NPI number. Individuals and organizations with an NPI must share their identifier with all relevant employers, insurers, clearinghouses, and other healthcare entities as needed for billing, administrative, and insurance related purposes.
If you want to practice therapy, bill insurance, run a practice, and fully comply with HIPAA standards, you will need to obtain an NPI. Any mental healthcare provider who is considered a “covered healthcare provider” under HIPAA and transmits health information electronically will need an NPI. Anybody who bills a government entity or private insurance for therapy services needs a unique identifier. An NPI is required for the vast majority of mental health providers.
There may be occasional instances as a cash-pay provider, who does not submit any billing or information electronically or on paper, where you may not need an NPI. However, even in these instances where a federal mandate may not apply, other organizations you interact with (such as liability insurance) may still require an NPI. It is imperative that you check with each organization affiliated with your practice to determine if you need an NPI number. Headway providers conducting private-pay sessions through the platform will still need an NPI.
Associates, limited license clinicians, and interns are all eligible to apply for an NPI number. The necessity of the NPI, however, depends on the policies and practices of the organization they work for. If you will not be submitting billing or transferring any health information, since a supervisor’s NPI number will be used, you may not need an NPI. Often, organizations still require an NPI for all their clinicians. It is best to consult with your supervisor and billing department at your organization to determine if an NPI is necessary for you. Headway does not currently credential limited license, associate, or intern providers.
There are multiple pieces of information that you need to gather for the NPI application. There are some differences in information required for a Type 1 individual application and Type 2 organization application.
Name
Type 1 NPI (individual): Full legal name (must match SSA records)
Type 2 NPI (organization/group practice): Legal business name (must match IRS records for EIN)
Other name(s)
Type 1 NPI: Any other names used (e.g., maiden, former, professional; optional)
Type 2 NPI: Any other business names (DBA, former legal business name, etc.; optional)
Date of birth
Type 1 NPI: Required
Type 2 NPI: Not required
Place of birth
Type 1 NPI: State and country of birth
Type 2 NPI: Not required
Social security number (SSN)
Type 1 NPI: Required (or ITIN)
Type 2 NPI: Not required
Employer identification number (EIN)
Type 1 NPI: Not required (unless incorporated as individual)
Type 2 NPI: Required (must match IRS records)
Mailing address
Type 1 NPI: Required
Type 2 NPI: Required
Practice location address
Type 1 NPI: Required
Type 2 NPI: Required
Business phone number
Type 1 NPI: Required
Type 2 NPI: Required
Email address
Type 1 NPI: Required
Type 2 NPI: Required
Provider taxonomy code
Type 1 NPI: Required (select specialty, e.g., psychologist, counselor)
Type 2 NPI: Required (select single or multi-specialty as well as individual specialty)
State license information
Type 1 NPI: Required if applicable (license number and state)
Type 2 NPI: Required if applicable (for organization or supervising providers)
Other provider IDs (Medicare/Medicaid)
Type 1 NPI: Optional
Type 2 NPI: Optional
Endpoints (for data sharing)
Type 1 NPI: Optional
Type 2 NPI: Optional
Contact person
Type 1 NPI: Required (may be self)
Type 2 NPI: Required (name, phone, email for organization contact)
Subpart information
Type 1 NPI: Not applicable
Type 2 NPI: Required if the organization is a subpart of a larger entity (parent EIN/name)
Certification statement
Type 1 NPI: Must be read and agreed to
Type 2 NPI: Must be read and agreed to
Note: Applying for your NPI is always free. If any website or individual is requesting money for the NPI application process, it is fraudulent.
Login/create an account: Go to the NPPES website and either log in or sign up for a new account. If you already have an individual account and NPI, you can log in to the same account to create your Type 2 Organization NPI. Multifactor Authentication is required.
Select individual or organization: You will see options that state “Apply for an NPI for myself” (Type 1) or “Apply for an NPI for an organization” (Type 2). Click the button that fits your situation.
Enter individual information: Enter your provider information for a Type 1 individual application (Name, title, birth information, SSN). For a Type 2 organization application, select that you are an employee of the organization.
EIN and business name (type 2 organization application only): Enter the EIN and business name for your organization.
Subpart (type 2 organization application only): You will be prompted to respond ‘Yes’ or ‘No’ when asked if your organization is part of a larger business or organization entity. In most cases, if you are just setting up your own practice, you should answer ‘No’.
Authorized official for the organization (type 2 organization application only): Enter the information of the individual who is the authorized official. If you are applying for your own organization, you will input your individual information.
Mailing address and practice location: For Type 1 and Type 2 applications, you will provide the mailing address and practice location for your organization or individual practice. You have the option to add languages spoken and hours of operation for the practice location. You are able to input multiple practice locations if applicable, but must select a primary location.
Endpoints: This is one of the more confusing aspects of the application. This is a chance to enter standardized locations on computer networks that can share protected health information. This may be necessary if your organization works closely with hospitals or doctors offices for example. Entering this information is optional and in most cases is not necessary. This step can be skipped unless this type of data transfer is central to the operations of your organization.
Other identifiers: You will be prompted to input any other identifiers you have such as a Medicare or Medicaid identifier. If you do not have any of these identifiers, skip this step. Do not enter your social security number or organization EIN during this step.
Taxonomy codes: This is also one of the most daunting parts of the application. For both Type 1 & Type 2 applications, you will search the drop down to select the taxonomy code that describes your area of practice as a provider (Clinical Psychologist, Clinical Social Worker, etc). If applicable, you may select more than 1 practice taxonomy code.
For Type 2 applications only, you will choose Single Specialty or Multi Specialty. Most private and group practices will choose the Single Specialty taxonomy since you will only operate with other mental health providers. A Multi Specialty practice would only apply if your organization will employ other types of providers such as primary care doctors.
Contact person: Enter the information for the main contact person that NPPES will interact with and send the NPI number to. You have the option to select that the contact person is the provider (Type 1) or authorized official (Type 2) previously entered.
Error check: The system runs an automated error check and provides any corrections that need to be made.
Submit: The final step is select the checkbox to certify the completion and submit the application.
Submitting a paper application via mail is the most common alternative method aside from an online application. This is most commonly used by those who do not wish to submit online or by those who do not have a Social Security Number and are required to use a different verification method. The application form can be downloaded from the Center for Medicaid and Medicare Services (CMS) website. After printing and completing the paper form, it can be mailed to the address listed on the document. Faxed and emailed applications will not be accepted.
The other alternative method of application is to apply through another designated CMS contractor. This method of application is rare but does apply in some instances.
The steps of the NPI application are guided in an easy to follow manner. The main mistakes when applying are related to input errors and omissions. Common input errors relate to provider and contact information, business EIN, and mailing/practice location information. If you are entering endpoints for data sharing, it is important to ensure that all information is provided and accurate. Taxonomy codes are also common mistakes. Ensure that you know exactly which codes you need to select. If the NPI and taxonomy codes do not align, it can cause challenges.
To ensure that these errors do not happen, it is most useful to take your time. Do not rush the application and make sure all information is complete and correct. For any areas of uncertainty make sure to review this article, the NPPES website and other online resources. Doing research in advance of submission can save you a lot of extra time and headaches. The NPPES FAQ Page can be a helpful source of information for completing the application.
After submitting your online application, the designated contact person will immediately receive an email with a tracking number for the submission. Most applications that are free of errors will receive their NPI within 24 hours. If further verification is needed, the NPI can take up to 30 days. The NPPES website suggests that if you have not received an NPI within 15 business days after your submission, to check the FAQs section. You may also reach out to their support team. A support phone number and email is provided in the submission confirmation email.
The NPPES and CMS request that any changes to your information is updated in your NPI profile within 30 days. Those changes can be completed through your NPI account that was already created on the NPPES. You would login to your profile, select the NPI account that you want to edit by clicking on the magnifying glass icon and then click on the pencil icon to begin. You can then navigate to the section you want to edit by using the left side menu or by clicking the next button. Enter the updated information (e.g. practice location, phone number, etc.). Finally, navigate to the final page to certify completion and submit the updates. You will receive a confirmation email with the updates. It is important for your practice to keep your information updated between the NPI account, CAQH account and insurance companies.
Setting up an NPI is one of the first steps towards being a therapist or establishing your private practice. The application process is straightforward when broken down into small steps. With your NPI and license in place, you will be ready to take on clients. Headway makes the client management, scheduling, and insurance billing process incredibly easy for therapists like you. Utilizing a platform that credentials you with insurance, submits claims, and manages payouts can save you time and free you to focus on client care.
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