Dental Benefits
National Provider Identifier (NPI)
Courtesy of the Dental Benefits Committee
CDS members are receiving letters warning them that if they do not obtain an NPI by May 2007, they will be in violation of HIPAA. These letters are being sent out by a third party hired by the federal government to handle NPI registrations.
If you file claims electronically, you must obtain an NPI before May 2007. However, there are benefits for all dentists to obtain an NPI. We’ve compiled the following information to help guide you through the registration process.
What is an NPI?
Who needs it?
How much does it cost?
What is the deadline?
How do I get one?
Who do I call if I have questions?
What is an NPI?
NPI stands for National Provider Identifier. It is a government-issued, 10-digit ID number for all health care providers.
There are two types of NPI. Type 1 is intended for the independent dentist. All dentists are eligible for a Type 1 NPI. You will need a social security number or individual tax identification number to apply for this type.
Type 2 NPIs are intended for dentists whose practice is an organization, such as a hospital, clinic, group care practice or corporation. If you are part of such a practice, you may wish to obtain both a Type 1 and Type 2. You will need an employer identification number to obtain a Type 2.
According to the American Dental Association:
“[I]t is entirely possible for an independent dentist with an incorporated practice to have both a Type 2 NPI for the incorporated practice and a Type 1 individual NPI.…[This way,] the dentist achieves practice flexibility if required to distinguish a human being who provided services from the practice entity. Down the road this may help ensure that tax responsibilities are properly assigned.”
Who needs it?
If you file claims electronically, you are required to obtain an NPI by May 23, 2007, according to the Health Insurance Portability and Accountability Act.
Even dentists who file claims by mail or fax only can benefit from an NPI because
- NPIs will eventually be accepted by all dental plans as a valid provider ID
- You do not have to maintain separate IDs as required by various dental plans
- Standardization may improve transaction acceptance rates
How much does it cost?
You can obtain an NPI free of charge. There is no need to pay a third party to register your or to purchase an implementation kit.
What is the deadline?
If you file claims electronically, you must obtain one before May 23, 2007. The American Dental Association advises allowing up to one month after you have completed the registration process to receive your NPI.
Dental insurers may begin asking you for your NPI months before the deadline.
How do I get one?
You can apply for an NPI at https://nppes.cms.hhs.gov/NPPES/Welcome.do
You can receive a paper application in the mail by calling (800) 465-3203 or TTY (800) 692-2326. You can also request a paper application through the Web site listed above.
Who do I call if I have questions?
The American Dental Association has compiled a list of resources on NPIs at http://www.ada.org/prof/resources/topics/npi.asp
You can e-mail the ADA with your questions at NPI@ada.org or call (312) 440-2500, extension 4608, for assistance.
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