National Provider Identifier (NPI)
Delta Dental recommends that all dentists obtain and use a National Provider Identifier (NPI).
Benefits of an NPI
- Eliminates the need to maintain and match identification numbers to specific payers for transactions
- Allows you to relocate your practice or change specialties without requiring new identifiers from multiple payers
- Helps reduce costs and simplify health care transactions
- Contributes to more efficient coordination of benefits
The federal Health Insurance Portability and Accountability Act (HIPAA) requires you to obtain an NPI if you submit claims electronically or if you check claims status or access patient eligibility and benefits information online. However, some health plans may choose to require NPIs on all transactions.
Obtaining your NPI is simple and once obtained, it stays with you for life. To obtain your NPI, simply go to the National Plan and Provider Enumeration System and follow the instructions to complete the application.
What is an NPI?
- A 10-digit random number unique to each health care provider or organization
- An NPI contains no coded information about the provider or organization
- A permanent identifier that does not change over time or expire
- A replacement for other identifying numbers currently used in electronic transactions, such as the Medicaid, Blue Cross and Blue Shield, UPIN, CHAMPUS and certain other "legacy" numbers
- Not a replacement for social security numbers, DEA numbers, taxpayer ID numbers, taxonomy (specialty) numbers or state license numbers
- Issued by the government through a third-party group, the National Plan & Provider Enumeration System (NPPES), which is responsible for processing applications and assigning numbers
Who Needs an NPI?
Every health care provider transmitting health information in connection with a standard transaction in electronic form must obtain an NPI. An NPI is required by the federal Health Insurance Portability and Accountability Act (HIPAA) for electronic transactions.
All individual health care providers (including dentists) and organizations such as clinics and group practices are eligible to obtain an NPI.
If you answer “yes” to any one of the following questions, you are considered a “covered entity” under the NPI standard and are required by federal law to obtain an NPI.
- Do you submit claims electronically?
- Do you use a clearinghouse?
- Do you submit claims attachments electronically?
- Do you use the Internet to obtain eligibility and benefits information or check on the status of claims?
Type 1 or Type 2 - Which NPI is Right For You?
There are two types of NPIs: Type 1, for individual health care providers, such as dentists and hygienists, and Type 2 for incorporated businesses, such as group practices and clinics.
- Type 1 is for the provider. This is the only type of NPI you will need if you receive payments in your name or under your social security number as a solo practitioner. For practices with multiple dentists, obtain a Type 1 NPI for each dentist.
- Type 2 is for group practices, incorporated dental practices or other business entities paid under their business or corporate name, or under their employer identification number (EIN).
On claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment.
Example:
On a standard ADA Dental Claim Form (#J400), the treating dentist’s NPI is entered in field 54 and the billing entity’s NPI is entered in field 49.
Do You Need Type 1, Type 2 or Both?
| Practice Type | NPI Type |
|---|---|
| Solo practitioner | Type 1 only, if claims are transmitted in the dentist's name and social security number |
| Individual dentist at one practice location | Type 1 for the dentist and Type 2 for the practice, if claims are transmitted in the practice’s name and Tax Identification Number (TIN) |
| Multiple dentists, one practice location | Type 1 for each dentist and Type 2 for the practice, if claims are transmitted in the practice’s name and TIN |
| Multiple dentists, multiple practices | Type 1 for each dentist and Type 2 for each practice with a separate TIN |
How to Apply
- Visit https://nppes.cms.hhs.gov
- Complete the application and follow instructions to submit either online or by mail. Faxes are not accepted.
- After confirmation of the receipt of your application, you should receive your NPI via e-mail within one to five business days if you submitted the application online. Mailed applications may require up to 20 days to process.
If any data related to your NPI changes (name, address, etc.), you are responsible for submitting an update to the NPPES within 30 days of the change.
Register Your NPI With Delta Dental
Please register your NPI with Delta Dental by providing us with a copy of the confirmation containing your NPI that you receive from the National Plan & Provider Enumeration System (NPPES). Send it to your local Delta Dental by e-mail, fax or U.S. mail:
California:
- E-mail:
- dentist_services@delta.org
- Fax:
- 916-852-8995
- U. S. Mail:
- Delta Dental, Attn: DNAC, P.O. Box 997330, Sacramento, CA 95899-7330
Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas and Utah:
- E-mail:
- dnac@ddic.delta.org
- Fax:
- 770-641-5395
- U. S. Mail:
- Delta Dental, Attn: DNAC, P.O. Box 1809, Alpharetta, GA 30023-1809
Delaware, District of Columbia, Maryland, New York, Pennsylvania and West Virginia:
- E-mail:
- ddpdentist_services@deltadentalpa.org
- Fax:
- 717-774-1770
- U. S. Mail:
- Delta Dental, Attn: DNAC, 1 Delta Drive, Mechanicsburg, PA 17055
For other Delta Dental member companies, please check how they prefer to register your NPI. Simply submitting it on a claim will not ensure that it's entered into the Delta Dental system.
When to Use Your NPI on Claims
Once you’ve registered your NPI with Delta Dental, you should begin using it on claims. Delta Dental recommends that the NPI be used on all claims.
Enter the NPI of the billing dentist or dental entity, as well as the treating dentist’s NPI (if they are different).
Use new claim forms that accommodate the NPI by providing a specific space for it. (This might require you to upgrade your software.)
Frequently Asked Questions
I submit paper claims and don't use the Internet to check patient eligibility and benefits. Do I still need an NPI?
If you don’t conduct any electronic transactions governed by HIPAA, you aren’t required to obtain an NPI. However, we strongly encourage you to get one, because you can use it as a single unique identifier with all payers.
How is the NPI Determined?
NPIs are issued by the National Plan & Provider Enumeration System (NPPES). The NPI contains no embedded intelligence – no coding that would identify the dentist’s state or license number, for example. It is simply a random number that does not expire.
How will the NPI affect other numbers I've used in the past?
The NPI replaces other identifying numbers used in electronic transactions, such as:
- Medicaid
- Blue Cross and Blue Shield
- UPIN
- CHAMPUS
- Certain other legacy numbers
The NPI will not replace these numbers, which are used for purposes other than general identification:
- Social Security
- DEA
- Taxpayer Identification
- Taxonomy
- Your state license
Where can I get help with the NPI application?
The NPI Enumerator will help you with your NPI application and to update your information in the NPPES.
| E-mail: | customerservice@npienumerator.com |
|---|---|
| Telephone: | 800-465-3203 / 800-692-2326 (NPI TTY) |
|
Get More Information
The information provided here is for educational purposes only and should not be interpreted as legal advice. Dentists are encouraged to seek their own legal advice about how the NPI pertains to their practices and circumstances.
