What is a provider group?

You do not bill for yourself. You bill for doctors, grouped into practices. A provider group is one of those practices.

Its page is the practice’s home base, and everything the practice owns hangs off it:

• Identity. The group’s name, its group NPI, and its tax ID.
• How it is doing. Four tiles: total claims, how many were denied, how many are still pre-filing, and the dollars tied up in denials.
• Organization details. Specialty, address, contacts. These are the details the clearinghouse and payers expect to match, so keep them current.
• The clearinghouse connection. Whether this group is registered, and its ID there. See What does registering a group with the clearinghouse do?.
• The price list. See What is a fee schedule?.
• The physicians who work under the group, each with their own NPI.
• The payer enrollments, one row per payer and per kind of message.
• The claims this group has filed, all in one place.

A claim always names both: the group that bills, and the doctor who treated the patient. That is why the group and the physician are separate records rather than one.