Please send us your National Provider Identifier by completing this form so we can update our files.

Q. What is the NPI?
A. 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.

Q. Who is required to apply for an NPI?
A. 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 and

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. In South Dakota, use of the NPI by providers is required for electronic claims only. Some other states are requiring providers to use their NPI on paper and electronic claims by May 23, 2007.

Q. Do I need to sign up?
A. All healthcare providers, defined under the regulation to include dentists, 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. Dental providers who access claims information or benefits via the Internet are also covered entities. Clearinghouses are also required to be able to accept and transmit the NPI by the federal compliance deadline.

Q. When is the deadline?
A. Providers submitting claims electronically must use NPIs on all claims by May 23, 2007. To ensure a smooth transition, all 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.

Q. How is my NPI determined?
A. 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.

Q. Will the NPI replace other numbers I use?
A. The NPI will replace other identifying numbers currently used in electronic transactions, such as your:

Numbers issued by plans and insurers (e.g. Blue Cross and Blue Shield number)

Medicaid provider number

Medicare provider number

CHAMPUS number

Other "legacy" identification numbers

The NPI will not replace numbers used for purposes other than general identification, such as your:

Social Security Number

DEA number

Taxpayer ID number

Taxonomy number

State license number

The NPI will replace all other identification numbers, but your Taxpayer ID number (or Social Security
     Number) will still be required for 1099 purposes.

Q. How do I apply for my NPI?
A. 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: To request a paper application, call NPPES at (800) 465-3203. When you apply for your
     NPI, you will be asked to provide your 10-digit taxonomy code. For quick reference, here are the
     dental taxonomy codes:

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.

Q. What are the advantages of the NPI?
A. Use of the NPI has 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

Q. What do I do with my NPI once I have it?
A. Please don't submit your NPI to us or begin using it until you receive notification from Delta Dental. You will be notified in advance of the required date. Please watch for updates in our provider newsletter. 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.

Q. Where can I go for additional help and information?
A. This Web site will have NPI updates so check back periodically. Articles will also be included in our newsletter. Here are some helpful Internet resources:

The federal government's NPI Web site

The federal government's NPI tutorial slideshow (best with high-speed internet connection)

NPI application help (Phone assistance is available at 1-800-465-3203)

The American Dental Association's NPI Web page