- What is the NPI?
Part of the Health Insurance Portability and Accountability Act (HIPAA), the National Provider Identifier (NPI) regulation establishes one unique identifier for each health care provider. Issued on January 23, 2004, the NPI regulation seeks to eliminate multiple identifiers currently in use. back to top
- What are the advantages of using the NPI?
Using the NPI should result in 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
-- a more efficient coordination of benefits
-- an easier process for health plans to track transactions and avoid duplication back to top
- What if I only submit paper claims?
If you do not submit electronic transactions governed by HIPAA, which includes claims or benefits inquiries via the Internet, you are not required to obtain an NPI. However, Ascent Benefits Company strongly encourages you to obtain and use an NPI to submit all of your claims once we are prepared to accept it. This will enable you to maintain only one unique identifier for use with all payers. back to top
- How do I apply?
According to the Centers for Medicare & Medicaid Services (CMS), you be able to apply for your NPI in one of the following ways:
You may apply through an easy web-based application process. The web address is https://nppes.cms.hhs.gov.
You may prepare a paper application and send it to the entity that will be assigning the NPI (the Enumerator) on behalf of CMS, beginning July 1, 2005.
A copy of the application, including the Enumerator’s mailing address, will be available on http://www.cms.hhs.gov/NationalProvIdentStand/03_apply.asp. You may also call the Enumerator for a copy. The phone number is 1-800-465-3203 or TTY 1-800-692-2326.
It is estimated that applicants will receive their NPI within 10 days after a properly completed application is received. Once you have been assigned an NPI, you must furnish updates to its data within 30 days of any changes.
You may receive notices about the NPI from other dental plans with which you do business, but remember, you need apply only once for an NPI. The same NPI is used for every dental plan, however you must notify each dental plan of your NPI separately. back to top
- What is a “Provider Taxonomy Code”?
When you apply for your NPI you will be asked to provide “your 10-digit taxonomy code.” These codes are not “assigned” to health care providers; rather, health care providers select the taxonomy code(s) that most closely represents their education, license, or certification. For dental providers it is essentially an identifier that corresponds most closely to area of specialty. In lieu of a taxonomy code, you may provide a written description of your specialty in the space provided on the electronic or paper application, and you will be assigned the closest appropriate code. To facilitate your registration, the taxonomy codes applicable to dentists are listed below.
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 back to top
- When is the deadline for application?
All HIPAA “Covered Entities” must use NPIs on all HIPAA-governed transactions by May 23, 2007. To assure a smooth transition, all providers are urged to apply for their NPI well in advance of the compliance date. back to top
- How will the NPI affect other numbers I’ve used in the past?
The NPI will replace other identifying numbers currently used in electronic transactions, such as the Medicaid, Blue Cross and Blue Shield, UPIN, CHAMPUS, and certain other “legacy” numbers. The NPI will not replace the Social Security Number, DEA number, Taxpayer ID number, taxonomy number, or state license number, since these are used for purposes other than general identification. Taxpayer ID numbers or Social Security Numbers must still be provided for 1099 purposes, but the NPI will replace all other identification numbers on the claim. back to top
- How is my NPI determined?
The NPI is a random ten-digit number (nine digits plus a check digit to detect keying errors) that never expires. It contains no inherent information about the provider, such as state of residence or license number. NPI's are issued by 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. back to top
- What do I do with my number once I have it?
Once you receive your NPI, please send a copy of the original document to Ascent Benefits Company at P.O. Box 41698 Phoenix, AZ 85080-1698 – Attention Professional Relations, so that we can input it into our system. You may also fax the original form directly to Professional Relations at to 888.272.8714. Ascent Benefits Company will then enter your NPI into our system. However, please don’t begin using it on claims and other transactions until you receive notification from Ascent Benefits Company that we are accepting the NPI. Please contact clearinghouses and other carriers with which you do business for instructions about their transition plans for use of the NPI. back to top
- Where can I go for additional help and information?
To access current information, please visit the federal government’s Web site, which includes links to a question and answer database, at
http://www.cms.hhs.gov/NationalProvIdentStand/
http://www.cms.hhs.gov/hipaa/hipaa2/
The American Dental Association’s HIPAA Web page is located at www.ada.org/prof/resources/topics/hipaa/index.asp
Contact our professional relations department at 888.651.7643. back to top
- Who is required to apply for an NPI?
All health care 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 covered entities, and clearinghouses are also required to be able to accept and transmit the NPI by the federal compliance deadline.
In addition to dentists who are considered “Covered Entities,” the broad definition of health care “provider” provided in the regulation encompasses all who provide health care services: individuals (including dental hygienists, physicians and all other practitioners) as well as organizations (such as hospitals, pharmacies, clinics and medical supply companies). back to top
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