Entity Codes in Medical Billing: What You Need to Know

Entity Codes in Medical Billing: What You Need to Know

If you’re involved in medical billing or healthcare administration, you’ve probably heard of entity codes. These codes are a crucial part of the medical billing process, and understanding how they work is essential for accurate and timely reimbursement.

In this blog post, we’ll cover everything you need to know about entity codes in medical billing, including what they are, why they’re important, and how to get one.

What is an Entity Code?

An entity code, also known as a National Provider Identifier (NPI), is a unique identifier assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). This five-digit number is used to identify providers for billing and administrative purposes.

The NPI replaced the older Provider Identification Number (PIN) system, which was used prior to 2007. The NPI is a standard identifier used by all healthcare payers, including Medicare, Medicaid, and private insurers.

Why are Entity Codes Important?

Entity codes are important for several reasons:

  1. Accurate Claims Processing: Insurance companies use entity codes to verify that the healthcare provider who provided the services is eligible to receive payment.
  2. Identification of Providers: Entity codes allow healthcare providers to be easily identified, which is essential for communication and coordination of care.
  3. Regulatory Compliance: The Health Insurance Portability and Accountability Act (HIPAA) requires that healthcare providers use standard identifiers, such as the NPI, when conducting electronic transactions.

How to Get an Entity Code

To get an entity code, healthcare providers must register with the National Plan and Provider Enumeration System (NPPES), which is run by the CMS. Providers can apply for an NPI online or by mail.

To apply for an NPI online, providers will need to create an NPPES account and provide their personal and professional information, including their name, business address, and specialty. The application process typically takes about 20 minutes to complete.

If a provider prefers to apply by mail, they can download a paper application from the NPPES website and submit it along with any required documentation.

Once a provider has been assigned an entity code, it will be included in the NPI registry, which is publicly available on the CMS website. Providers can also use their entity code to update their information in the NPPES system as needed.


Entity codes are an essential part of the medical billing process. They allow healthcare providers to be easily identified, ensure accurate claims processing, and help providers comply with regulatory requirements.

If you’re a healthcare provider, it’s important to understand how entity codes work and to ensure that you have an NPI assigned to you. By taking these steps, you can help ensure that your billing and reimbursement processes run smoothly and efficiently. Get a quick consutlation with one of our dedicated billing manager to discuss in detail.

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