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Reminder for dentists: Correct use of your Type 1 NPI helps ensure accurate electronic claims processing

Are you experiencing ongoing problems with your federal dental program* electronic claims because of a Type 1 NPI issue? If so, here are some steps you can take to make sure the Type 1 NPI is correct when submitting your electronic claims:

  1. First, verify your Type 1 NPI with the National Plan and Provider Enumeration System (NPPES).
  2. Once you’ve verified the NPI, contact your local Delta Dental member company to make sure your Type 1 NPI matches Delta Dental’s National Provider File (NPF) record. This is important because the NPF contains dentist data files shared by all Delta Dental member companies for processing claims and includes information about dentists’ network participation status and fees. If any corrections to your NPF record are necessary, the local member company must make them.
  3. If the problem with your claims persists after you’ve completed steps 1 and 2, check with your software vendor or clearinghouse to make sure your Type 1 NPI isn’t being inadvertently dropped or replaced with the Type 2 NPI during the transmission of your claim to Federal Government Programs (Delta Dental’s division that handles federal dental program claims processing). Remember to list the Type 1 NPI in box 54 of the electronic claim form so our processing system is able to pick up this information from your claim and match it to the information in our system.

To request reprocessing of your claim, simply note the correct Type 1 NPI on the Explanation of Benefits (EOB) form and return the EOB to: Delta Dental of California, Federal Government Programs, P.O. Box 537007, Sacramento, CA 95853-7007.

Please refer to the online Federal Government Programs Dental Office Handbook for more information about NPIs and a list of the some of the policy codes used in processing electronic claims.

*Federal dental programs administered by Delta Dental of California under contract with various federal government agencies: The TRICARE Retiree Dental Program, the Federal Employees Dental Program, the Veterans Affairs Dental Insurance Program, and the Office of the Comptroller of the Currency (OCC) Dental Insurance Program.

There are two types of NPIs: Type 1 NPI, for a individual health care provider, such a dentist who receives payments in his/her name as a solo practitioner; and Type 2 NPI, for incorporated businesses, such as a group dental practice, clinic or other business entity paid under its business or corporate name.

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