Dental Provider Newsletter - October 2018

May a dentist bill EMI Health under another dentist’s name and NPI?

In general, EMI Health requires dentists to submit claims under their own names and NPIs.

What if one dentist is employed by another dentist?

If a dentist works for a dental organization or incorporated individual, that organization’s name and Type 2 NPI is submitted as the billing provider. However, the dentist performing the services must report his or her name and NPI as the rendering provider. Just because a dentist works for another dentist does not mean the employing dentist may submit claims on behalf of the employee—even temporarily while a new employee waits for credentialing to be completed.

What if one dentist is supervised by another dentist?

All dentists must bill EMI Health directly for services they render, regardless of whether they are contracted with EMI Health or supervised by another dentist.

NPI basics

Type 1: Individual providers are each required to obtain a Type 1 (individual) NPI. An individual is eligible for only one Type 1 NPI, and Type 1 NPIs may not be shared among providers in an organization.

Type 2: Providers who are organizations, including healthcare groups and individuals who have incorporated their practices, must also obtain a Type 2 (organizational) NPI. Large corporations may have subparts that need to be uniquely identified with their own Type 2 NPIs.

Billing: When submitting claims, the individual Type 1 NPI is used to identify the provider who performed the service, while the organizational Type 2 NPI identifies the entity to be paid. Individual unincorporated providers may use the Type 1 NPI for billing and rendering.