ALBANY, New York – The NPI is a 10-digit standard identification number that will replace the current provider identification information used—usually referred to as legacy identifiers. It will be required on all HIPAA standard transactions.

Dentists who only use paper, voice and fax to transmit these communications may find NPIs on paper claims useful for other reasons, such as benefiting from a single standard identifier that will replace several legacy identifiers, or it may be required in some states to use NPIs on paper claims.

What is a HIPAA standard electronic transaction?

A HIPAA electronic standard transaction is a communication about claims or benefits-related information that exists in some kind of electronic media such as a tape, disk, hard drive, back up or flash card and is either physically transported while in that electronic media, or transmitted via Internet, extranet or private or leased line to another computer for processing. The most common HIPAA standard electronic transactions used by dentists are electronic claims and eligibility inquiries.

Other HIPAA standard electronic transactions used by dentists include electronic remittance advice and claim status inquiries. Communications by typical stand-alone fax machines and voice communications by telephone are excluded.

Am I a Type 1 or Type 2?

There are two types of NPIs available to dentists and dental practices—Type 1 and Type 2.

Type 1 enumeration distinguishes an individual provider as a health care provider who is operating independently. All dentists are eligible to apply for a Type 1 NPI, regardless of whether or not they file electronic transactions and are required to have an NPI under HIPAA.

Type 2 enumeration is for a health care provider that is an organization, such as a hospital, clinic, group practice or corporation, including incorporated dental practices. Type 2 organization providers may wish to also enumerate their individual provider employees as Type 1 providers to distinguish them individually to avoid possible delays in payment.

Payers may want the individuals in the organization to obtain NPIs for mapping purposes or developing directories for their dental plans.

How do I apply for the NPI?

Dentists are reporting that it takes about 20 minutes to apply for a national provider identifier from the National Plan and Provider Enumeration System.

Visit https://nppes.cms.hhs.gov to submit an application. After receiving confirmation of receipt, the NPI will arrive via e-mail in one to five business days. Processing of paper applications and NPI receipt from the U.S. Postal Service typically takes 20 business days.

For help with the process e-mail customerservice@npienumerator.com or call 1-800-465-3203.

Questions, comments or concerns may be directed to the ADA at NPI@ada.org. Those without e-mail or members who would prefer to talk to a staff member may call the American Dental Association (ADA) directly and ask for Ext. 4608.

SOURCE: New York State Dental Association

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