South Dakota Dental Association : Regulatory & Compliance National Provider Identifier

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Regulatory & Compliance : National Provider Identifier

National Provider Identifier (NPI)

Anyone who uses standard electronic transactions, like electronic claims, eligibility verifications, claims status inquiries and claim attachments, is required by federal law to use NPIs on all electronic transactions. In addition, those dentists who use only paper, voice and fax to transmit these communications may find NPIs useful or necessary for other reasons. The ADA encourages all dentists to obtain and use a NPI, particularly those using (or planning to use) electronic transactions. The NPI will replace other identification numbers issued by health plans and will be required for electronic transactions and, at insurers' discretion, for paper transactions. Dentists can apply online at http://nppes.cms.hhs.gov.

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Annual Maximums on Adult Dental Medicaid Benefits

The Medicaid Solutions Task Force has recommended a $1,000 annual maximum on Adult Dental Medicaid benefits. There is no legislation on this issue. This change will be made through an amendment to the “State Plan” for operating Medicaid and will be reflected in the general appropriations bill. An exemption is expected to be made for “emergencies”. This would include cases requiring general anesthesia and extensive care for special needs patients will be exempted from the annual maximum. The SDDA Dental Health Committee will meet with the Department of Social Services regarding revisions to the Medicaid Plan Amendment.