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Avoiding claims rejected for NPI-Tax ID mismatch
April 29, 2019

This article is for all dental providers.

Last year, we began denying paper and electronic dental claims submitted without the correct NPI (Type 1 and 2) and Tax ID numbers in their appropriate boxes. (Please refer to the resources below for our April 9, 2018 News Alert.) Because we are still seeing many claims that are denied unnecessarily, we want to remind you about how to avoid rejected claims.

How to bill correctly

If you are an individual or sole proprietor If you are a group practice
List your:
  • Type 1 NPI in box 49
  • Individual Tax ID in box 51
  • Type 1 NPI in box 54
List:
  • Your Type 2 NPI in box 49
  • Your Organization’s Tax ID in box 51
  • The treating provider’s individual Type 1 NPI in box 54.
  • Note: Group practices include dentists contracted as a PC (Private Corporation), LLC (Limited License Corporation), Inc. (Incorporated), PLLC (Private Limited License Corporation), or another organizational entity.

If you submit paper claims
We recommend electronic claim submission because it:

  • improves your claim payment
  • reduces claim errors
  • increases productivity and efficiency
  • saves 50 to 70 percent of time spent on billing.

However, if you must submit a paper claim, you are required to use the most current 2012 ADA claim form (see the sample 2012 claim form below.)

How to resubmit denied claims
Claims that have been denied due to a mismatch between the NPI and tax ID cannot be adjusted by the Dental Information Center. Please resubmit the corrected claim for processing with the correct NPI and Tax ID numbers. For more information, refer to your Dental Blue Book.

Log in for these resources

  • For the April 9, 2018 News Alert, go to News>Claims, Coding, Payment and scroll to the title, We will deny dental claims billed without correct NPI and Tax IDs.
  • To learn about electronic claim submission, go to eTools>Direct Connection.
  • For Section 5: Claims and Pre-treatment Estimates in your Dental Blue Book, go to Office Resources>Policies & Guidelines>Provider Manuals.

MPC_012219-1M-3-ART

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