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2. What is the NPI?
3. What are the advantages of the NPI?
4. How is my NPI determined?
5. Who is required to apply for an NPI?
6. What if I only submit paper claims?
7. When is the deadline?
8. Will the NPI replace other numbers I use?
9. How do I apply for my NPI?
10. What do I do with my NPI once I have it?
11. Where can I go for additional help and information?
~ Dentists, please send us your NPI by filling out this form so we can update our files.
1. Do I need to take any action?
If you are a dentist who submits electronic claims, you must apply for an NPI and understand the requirements for its use.
2. What is the NPI?
The National Provider Identifier (NPI) is part of the Health Insurance Portability and Accountability Act (HIPAA). The NPI regulation establishes one unique identifying number for each health care provider. This simplification measure will pare down the number of identifiers currently used in health care transactions.
3. What are the advantages of the NPI?
Use of the NPI will have several advantages, including:
- One unique provider identifier for all health plans to utilize
- A permanent provider identifier that will not change in the event of practice relocation or changes in specialty
- An easier process for health plans to track transactions and avoid duplication
The NPI is a random ten-digit number (nine digits plus a check digit to detect keying errors). It never expires. It contains no inherent information about the provider, such as state of residence or license number. NPI numbers are administered by the Centers for Medicare and Medicaid Services (CMS), which has contracted with the National Plan and Provider Enumeration System (NPPES). The federal government is also responsible for assisting providers in completing the application and resolving problems associated with an NPI.
5. Who is required to apply for an NPI?
All health care providers are eligible to receive an NPI. However, only "Covered Entities" are required to obtain an NPI. A dental provider is a "Covered Entity" if he or she transmits electronic transactions governed by HIPAA, primarily electronic claim transactions.
The broad definition of health care "provider" in the federal regulation encompasses all who provide health care services:
- Individuals - such as physicians, dentists and pharmacists
- Organizations - such as hospitals and clinics
Although dental assistants and hygienists are "providers" and are thus eligible to obtain an NPI, they are only required to do so if they submit claims for their services.
6. What if I only submit paper claims?
If you do not submit electronic claims, you are not required to obtain an NPI. However, Delta Dental strongly encourages you to obtain and use an NPI, once we are prepared to accept it. This will enable you to maintain only one unique identifier for use with all payers.
7. When is the deadline?
All HIPAA "Covered Entities" must use NPIs on all claims by May 23, 2007. To ensure a smooth transition, providers are urged to apply for their NPI well in advance of the compliance date.
Clearinghouses are also required to be able to accept and transmit the NPI by May 23, 2007.
8. Will the NPI replace other numbers I use?
The NPI will replace other identifying numbers currently used in electronic transactions, such as your:
The NPI will not replace numbers used for purposes other than general identification, such as your:
The NPI will replace all other identification numbers, but your Taxpayer ID number (or Social Security Number) will still be required for 1099 purposes.
You only apply for your NPI once, and your NPI is permanently assigned for your lifetime. There is no cost to apply.
You may apply for your NPI either:
- Online: Complete a web application and submit it electronically
- On Paper: Print an Adobe Acrobat (PDF) version of the application and mail it to the address provided. You may also call NPPES to have an application sent to you. Call 1-800-465-3203 or TTY 1-800-692-2326.
- General Practice - 1223G0001X
- Dental Public Health - 1223D0001X
- Endodontics - 1223E0200X
- Oral and Maxillofacial Pathology - 1223P0106X
- Oral and Maxillofacial Radiology - 1223X0008X
- Oral and Maxillofacial Surgery - 1223S0112X
- Orthodontics and Dentofacial Orthopedics - 1223X0400X
- Pediatric Dentistry - 1223P0221X
- Periodontics - 1223P0300X
- Prosthodontics - 1223P0700X
- Denturist - 122400000X
After you receive your NPI, you must furnish any updates to the NPPES. If any of the data you submitted on your application changes, notify NPPES within 30 days of the change.
You may receive notices about the NPI from other health and dental plans, but your unique NPI is used with all plans. Remember to notify each dental plan of your NPI separately.
10. What do I do with my NPI once I have it?
If you haven’t done so already, please send us your NPI now so it won’t affect your claims. Please remember to continue to include your TIN and License on the claim.
Other health and dental plans may have differing timelines for NPI implementation, so take notice of each plan's requirements.
In addition, you will want to contact your clearinghouse for instructions about their transition plans for using the NPI.
11. Where can I go for additional help or information?
This Web site will have NPI updates so check back periodically. Also, watch your Special Edition newsletter for articles on the NPI.
Here are some helpful Internet resources:
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