Once you are assigned a 10-digit unique National Provider Identifier (NPI) number, it is yours for life. Virtually any insurance carrier should be able to identify you by your NPI, replacing non-standard identifiers and streamlining claims processing. However, it will not replace your social security number, DEA number, taxpayer ID, taxonomy (specialty) number or state license number.
An NPI is required if your office does any HIPAA-related standard electronic transactions. Some of the main activities that require an NPI include verifying enrollee eligibility, confirming enrollee benefits, submitting electronic claims (online or through a clearinghouse) and checking your claim status. If you don’t have your NPI yet, you should definitely consider getting one soon. Here are some reasons why we think it’s a great idea:
- Simple to apply for an NPI and free
- Doesn’t tie up office staff time by waiting on phone; more time to spend with enrollees
- Leverage technology that other dental offices use
- Streamlines your office activities with easy-to-use, NPI-required online tools
- Recognized as a valid identifier by all insurance carriers, which contributes to more efficient coordination of benefits
- Allows you to relocate your practice or change specialties without requiring new identifiers from multiple payers
Which Type of NPI Do I Need?
Type 1 is for individual health care providers, such as dentists and hygienists. This is the only type of NPI you need if you receive payments in your name or under your social security number as a solo practitioner. For practices with multiple dentists, each dentist should obtain their own ‘Type 1’ NPI.
Type 2 is for group practices, incorporated dental practices or other business entities paid under their business or corporate name, or under their employer identification number (EIN). On claims, the Type 2 NPI identifies the payee and may be submitted in conjunction with a Type 1 NPI to identify the individual dentist.
In summary, a Type 1 NPI is needed for each provider, and a Type 2 is needed for each business (e.g., separate TIN#).
How Do I Apply for My NPI?
An NPI is issued by the government through the National Plan and Provider Enumeration System (NPPES). NPPES will process your application and assign your NPI.
- Visit https://nppes.cms.hhs.gov or call
- Complete the application (approximately 20 minutes), and follow the instructions to submit either online or by mail. Faxes are not accepted.
- If you submit via email, you will receive your NPI via email within 1-5 days after you get confirmation of your completed application. If submitted by mail, it may take up to 20 days to process.
If any data related to your NPI changes (name, address, etc.), you are responsible for submitting an update to the NPPES within 30 days of the change.