National Provider Identifier (NPI)
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:
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:
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:
NPI, you will be asked to provide your 10-digit taxonomy code. For quick reference, here are the
dental taxonomy codes:
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:
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:
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