National Provider Identifier
E-claims must include the dentist's Type 1 NPI
Federal law (HIPAA) requires all health care providers and organizations to use a standard identifier on all electronic transmissions that include patients' health information, such as electronically submitted claims. This standard identifier is the National Provider Identifier (NPI), and it is assigned by a federal government agency.
Any dentist can get an NPI and use it on both electronic and paper claims; however, as of May 23, 2008, all heath care providers and organizations that meet the HIPAA definition of a covered entity are required to use an NPI to identify themselves in HIPAA standard transactions.
Using the NPI
All e-claims sent to Delta Dental must include:
- The treating dentist's Type 1 identifier.
- The treating dentist's state license number.
- The tax identification number (TIN) of the billing dentist or practice.
Note: The Type 2 NPI may be entered in addition to the Type 1 NPI to identify the billing provider (such as a group practice).
Apply for your NPI
- Complete the application online at nppes.cms.hhs.gov.
- Download and complete a paper application or call 800-465-3203 to request an application. A vendor or clearinghouse may submit the application in an electronic file on behalf of the dentist.
Register your NPI
Dentists must register their NPI with Delta Dental by sending a copy of the document assigning their number to our provider records department:
Attention: Provider Records
PO Box 30416
Lansing, MI 48909-7916