Okay, I think I understand your question better.
One provider with two locations in different states:
Clinic 1:
Provider orders a blood draw which is done at clinic 1.
Specimen is sent out for testing to independent lab.
Lab performs test and bills.
Clinic 2:
Provider bills E/M office visit.
Questions:
Would claim at clinic 2 be denied due to NPI showing address of clinic 1?
Factors used to pay claim and does NPI address matter?
Answer to both these questions is: It isn't the address necessarily but the NPI entity type.
To clarify the address thing - how many times have you heard of doctors participating in health fairs?
These providers go to malls, conference centers, community centers, schools and religious institutions and conduct exams as a service to the community.
Now to the NPI entity type issue:
See highlighted info from the CMS website:
Also, you stated BCBS/Anthem and I found the following link which has claims submission guidelines regarding NPI for facilities and professionals.
The info coincides with the CMS info.
Is your provider acting as a:
sole proprietor?
part of a larger organization that allows physicians to also act independently?
individual provider who is incorporated?
There are three types of entities that can be assigned an NPI.
If he is practicing as a sole proprietor who happens to have multiple locations then billing with that one NPI should not be an issue.
If he is acting as part of an organization (for example clinic 2) then he needs to use the organization's NPI unless of course he is conducting business separate from the parent organization. If he is conducting business separate from the parent company then he has to use his NPI for billing services.
If he is an individual provider who is incorporated then he may have two NPIs. I have seen it where a provider has more than one location and he acts as a sole proprietor in location 1 and bills with their respective sole proprietor NPI. However, for services he conducts in location 2 he uses the incorporated NPI.