This article is for dentists and oral surgeons caring for our members
We’d like to remind you of the importance of using the correct fields for Type 1 and Type 2 NPIs. Please review the table below to determine which type of NPI to include in each field of the claim form.
|If you have this type of NPI:||Submit your paper claim using:||Submit your electronic claim using:|
|Type 1 NPI — for dentists contracted as individual or sole proprietor||The Type 1 NPI in Box 49 & 54 of the 2012 ADA Claim Form||The Type 1 NPI in the billing provider information section.|
|Type 2 NPI — for dentists contracted as a:
||The Type 2 NPI in Box 49 of the 2012 ADA claim form and
The individual provider’s NPI (Type 1) in Box 54.
|The Type 2 NPI in the Billing Dentist or Dental Entity provider information section and
The individual provider’s (Type 1) NPI in the Treating Dentist and Treatment Location Information section.
To make any changes to your NPIs, please be sure to:
Note: Out-of-state providers should check with your local Plan about how to make updates to your NPI.