National Provider Identifier (NPI) Frequently Asked Questions (FAQs)

A list of Frequently Asked Questions (FAQs) was developed for the National Provider Identifier (NPI) project to address common questions and concerns of Denti-Cal providers. The FAQs will continue to be updated with new information as the NPI project progresses.

For additional questions regarding NPI registration with Denti-Cal, contact the Provider Telephone Service Center (TSC) at 800-423-0507.

1. What is a National Provider Identifier (NPI)?
   
   A: The administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) required the Secretary of Health and Human Services (HHS) to adopt a national standard identifier for health care providers for use in the health care industry. On January 23, 2004, HHS published the NPI final rule that adopts the National Provider Identifier (NPI) as the standard unique health identifier for health care providers. The NPI is 10 digits in length and will replace the current Denti-Cal provider number (legacy ID) in use today.
   
   
2. How can a provider learn more about NPI?
   
   A: Visit the Centers for Medicare & Medicaid Services (CMS) HIPAA Web site for more information.
   
   
3. Does a provider need to apply for an NPI to submit claims to Denti-Cal?
   
   A: Starting on the compliance date of May 23, 2007, providers submitting claims electronically and those who obtain beneficiary eligibility via the Point of Service (POS) Device or the Internet will be required to use their NPI, however; all providers are encouraged to obtain an NPI.
   
   
4. How does a provider apply for an NPI with CMS?
   
   A: The Centers for Medicare amp; Medicaid Services (CMS) has established a National Plan and Provider Enumeration System (NPPES). For additional information, and to complete an application, visit the National Plan and Provider Enumeration System (NPPES) Web site .
   
   
5. Will the NPI replace a provider's current Denti-Cal number(s)?
   
   A: Beginning May 23, 2007, the 10-digit NPI will replace the Denti-Cal provider numbers for providers submitting electronic transactions.
   
   
6. Does Denti-Cal want to know my NPI information prior to May 23, 2007?
   
   A: Yes. Denti-Cal providers who have received their NPI from NPPES can register their NPI through the automated Denti-Cal NPI Collection system or by sending the Denti-Cal NPI Registration Form to Denti-Cal.
   
   
7. How does a provider register their NPI with Denti-Cal?
   
   A: Click on the Register NPI link below and follow the directions. In order to register, a provider must have the following information available:
   • Denti-Cal Billing Provider number, service office number, and PIN
   • Denti-Cal Rendering Provider number and last 4 digits of SSN (Social Security Number)
   • NPI assigned by the National Plan and Provider Enumerator System (NPPES)
   
   
8. When will Denti-Cal NPI registration start?
   
   A: Registration has begun.
   
   
9. How does a provider register multiple NPIs with Denti-Cal?
   
   A: The Denti-Cal NPI Collection System allows Denti-Cal providers to register one NPI for each active Denti-Cal provider number currently enrolled. Providers possessing more than one active Denti-Cal number will need to login separately for each existing number, and may enter the same NPI, or subpart NPI to replace their multiple Denti-Cal numbers.
   
   
10. Can a provider register more NPIs than existing Denti-Cal provider numbers?
    
    A: The National Provider Identifier Registration online system does not allow registration of more NPI numbers than existing Denti-Cal provider numbers. If your organization has more subpart NPIs than existing Denti-Cal provider numbers, please contact the Denti-Cal Telephone Service Center at 1-800-423-0507.
    
    
11. Can a provider continue to submit their current provider number along with their NPI?
    
    A: After the compliance date, May 23, 2007, the NPI will be the only health care provider identifier that can be used for electronic transactions.
    
    
12. On or after May 23, 2007, if a provider has a claim with a date of service prior to that date, should a provider use their Denti-Cal provider number on that claim or their NPI?
    
    A: Regardless of the date of service, electronic claims received by Denti-Cal on or after May 23, 2007 must use the NPI.
    
    
13. Has NPI information been published in the Denti-Cal Bulletins?
    
    A: Yes. To view previously published articles, visit the HIPAA page on the Denti-Cal web site.
    
    
14. When can providers submit claims/TARs after they've sent in a hardcopy registration form to Denti-Cal?
    
    A: Providers who submit a hardcopy NPI registration form to Denti-Cal must wait until they've received a confirmation letter from Denti-Cal verifying that their NPI(s) have been successfully processed.
    
    
15. When can providers submit claims after they've registered their NPIs via the Denti-Cal NPI Collection System?
    
    A: Providers who register via the Denti-Cal NPI Collection System must wait at least three business days before they can submit claims/TARs.
    
    
16. Why are providers getting the registration forms sent back to them as incomplete?
    
    A: Registration forms that are incomplete will be returned to providers. Please make sure that all of the required fields are completed accurately before submission.
    
    
17. Will claims and payments be affected if providers do not obtain separate NPIs for my separate service office locations (subparts)?
    
    A: Yes. Claims and payments may be delayed in order for Denti-Cal to locate the appropriate service office. Denti-Cal encourages qualifying providers to subpart.
    
    
18. Does my clearinghouse or billing service need my NPI?
    
    A: Yes. All clearinghouses and/or billing services will need the NPIs in order to submit claims/TARs for the providers and to be HIPAA compliant.