MEDDESKTOP: NPI

Thursday, March 19, 2009

ADA Provider Taxonomy Codes (NPI)

American Dental Association (ADA) has provided he National Provider Identifier (NPI) Provider Taxonomy Codes for Dentists, General Practitioners, and Dental Specialists. Any health care provider who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries, and claim attachments, is required by federal law to start including NPIs on electronic transactions not later than May 23, 2007. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. Many dental plans will require dentists to include NPIs on paper claim submissions, so even paper based dentists may find it a necessity to have NPIs. The ADA encourages all dentists to apply for NPIs, particularly those using (or planning to use) electronic transactions.
Following are provided by ADA and the official PDF file describing the same could be found following the link provided at the end of the article.

Provider Taxonomy Codes
Category / Description ------------------ Code
Dentist -------------------------------122300000X
A dentist is a person qualified by a doctorate in dental surgery (D.D.S) or dental medicine (D.M.D.) licensed by the state to practice dentistry, and practicing within the scope of that license.

General Practice ---------------------1223G0001X
Many dentists are general practitioners who handle a wide variety of dental needs.

Dental Specialty ----------------------Various (see following list)
Other dentists practice in one of the nine specialty areas recognized by the American Dental Association.

Dental Public Health -------------------1223D0001X
Endodontics ---------------------------1223E0200X
Orthodontics --------------------------1223X0400X
Pediatric Dentistry --------------------1223P0221X
Periodontics ---------------------------1223P0300X
Prosthodontics ------------------------1223P0700X
Oral & Maxillofacial Pathology ---------1223P0106X
Oral & Maxillofacial Radiology ---------1223D0008X
Oral & Maxillofacial Surgery -----------1223S0112X

Link to Provider Taxonomy Codes | PDF file/38k

Wednesday, March 18, 2009

National Provider Identifier (NPI) What Is It?

NPI Meddesktop
As administrative simplification provisions of HIPPA (Health Insurance Portability and Accountability Act of 1996) mandated the adoption of standard unique identifiers for health care providers and health plans. Purpose of these were to aid to improve the efficiency and the effectiveness of the exchange of the health information, electronically.
This means your Doctors, hospitals and health plans. These data is processed by CMS, The Centers for Medicare & Medicaid Services and the system is known as NPPES, the National Plan and Provider Enumeration System.
Health care providers are required to contact the NPI Enumerator and apply for an NPI. Any changes to the NPI is also handled by the NPI Enumerator. Also under the HIPPA Act, covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. Getting a NPI is free for Providers.
The NPI Registry (The NPI Database) could be searched by anyone and the data is public and could be downloaded if needed. The registry is kept updated daily.
The registry could be querried for NPI ot the legal business name. The NPI if free to access and use.
So Go and search for your health care provider at NPI Registry. See what you find.
Additional NPI Information;
CMS NPI Page

NPI Application / Update Form -

[PDF File]