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Use the correct NPI on your Dental Blue claims
August 20, 2020

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:
  • PC (private corporation) 
  • LLC (Limited License Corp)
  • Inc. (incorporated)
  • PLLC (Professional Limited Liability Company)
  • Any other organizational entity
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:

  1. Update your Billing Software with correct NPI/TIN.
  2. Contact your Clearinghouse to ensure they have the correct information.

Note: Out-of-state providers should check with your local Plan about how to make updates to your NPI.