What is it and how does it affect you as an Orthodontist/Dentist?

The National Provider Identifier (NPI) is a unique, government-issued, standard identification number for individual health care providers and provider organizations like clinics, hospitals, schools and group practices. The government has contracted with an external company for processing applications and developing these random 10-digit numbers for applicants.

Any health care provider who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries, and claim attachments, will be required by federal law to start including NPIs on electronic transactions not later than May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. Many dental plans will require dentists to include NPIs on paper claim submissions, so even paper based dentists may find it a necessity to have NPIs. The ADA encourages all dentists to apply for NPIs, particularly those using (or planning to use) electronic transactions.

The NPI has some advantages over identifiers now in use:

• Once implemented across the health care industry, the NPI will be accepted by all dental plans as a valid provider identifier on electronic dental claims and other standard electronic transactions.
• Dentists will not have to maintain multiple, arbitrary identifiers required by dental plans, nor will they have to remember which number to use with which dental plan.
• Introduces an important element of standardization to electronic transactions that should improve transaction acceptance rates

However, the NPI does not do any of the following:

• Replace the DEA number when required for prescribing controlled substances or other DEA-regulated activities.
• Replace state-issued licenses and certifications verifying a provider's licensing or qualifications.
• Replace Social Security Number, Individual Tax ID, or Employer ID for tax purposes.

The above article came directly from the ADA's website.

Click here to see another article on the ADA's website regarding NPI numbers.

Click here to implement the new 2006 ADA Insurance form in your Oasys program.