CDT PART 3

ADA’s new claim form

Editor’s note: this is the third article in a three-part series on changes to the American Dental Association’s Current Dental Terminology manual.

FOR PART 1 - CLICK HERE
FOR PART 2 - CLICK HERE

By Marianne Harper

Have you been wondering where to enter your practice’s National Provider Identifier (NPI) on the American Dental Association (ADA) Dental Claim Form?  Apparently, the ADA made that question their purpose when redesigning their form.  Effective January 1, 2007, a new dental claim form became available that addresses this concern along with several others issues.  

If you are not already aware of what the NPI is, the Centers for Medicare and Medicaid Services (CMS) states that “the NPI is a ten digit number that will be used to identify you to your health care partners, including all payers, in all HIPAA standard transactions”.  It will replace any other identifier already used.  There are two types of NPI and your practice may require both.

Solo practices
If your practice is a sole proprietorship, you will only be required to use the type one NPI but if it is an organizational type of practice or group practice, or if it is incorporated, you will be required to use a type 2 NPI.  However, if the practice is owned by an individual and is also incorporated, you may need an NPI for the dentist and one for the corporation.1  The requirement for the use of NPI was originally set for May 23, 2007.  However, the compliance deadline was postponed till May 23 ,2008.

The major change to the ADA claim form is that it provides areas in which to place the NPI.  Boxes 49 and 54 used to be titled “Provider ID”. These are the boxes that will now be used to enter the NPI and they are titled “NPI.”  Although it is not clearly indicated on the form, box 49 is to be used for the billing dentist’s NPI and box 54 is to be used for the treating dentist’s NPI.  

According to Patrick Canady, (Coordinator of Dental Informatics at the ADA), “if a practice is an organization and its management wants the claim payments made to the organization, not the treating dentist, then the type 2 NPI would go in the Billing Dentist or Dental Entity NPI field.  If the practice is an unincorporated sole proprietorship, than the proprietor doctor's type 1 NPI would be used instead, REGARDLESS of whether the doctor did the work.”

No specific rule
There does not appear to be a specific rule for providers who are required to have both types of NPI as to which number to use or whether both numbers would be needed.  According to Mr. Cannady, when asked what would be required in this situation, he responded that “the NPI rule does not have any preference as to which type of NPI is used for this purpose;  providers must enumerate and use their NPIs according to their business needs and the information requirements of health plans.

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