Open Dental Forum

We hired an associate dentist in our office a couple of months ago as an employee dentist. Our owner dentist is the sole proprietor, so payments are to come to his name. We will likely change that in the future, but for now it's our reality. We're having an issue getting payments from Delta specifically when she's the treating dentist. They're rejecting the claim because of an NPI mismatch. Because the owner's NPI is listed in the billing dentist section, which is correct, and her's is correct in the treating dentist NPI, but they're claiming a mismatch.

The rep said we should have a group NPI, but we don't. They said to leave the NPI on the billing dentist blank, but that doesn't work with electronic claims (clearinghouse rejects it when I attempted it). So, it looks like we have two realistic alternatives: 1) Print all claims for Delta with blank NPI for billing dentist; or 2) Get a group NPI.

Anyone have any suggestoins?

Something doesn't seem right. We have the same setup and no problems. I am the owner/treating dentist and my NPI is listed as billing dentist and the providers NPI (mine or my associates) is listed under treating dentist. Who is rejecting the claim? Is it Delta or the Clearing House? I bet its the clearinghouse and you need to add your associate to the account

It's Delta rejecting them. I spoke to a rep today and they told me it's their protocol to have either a group NPI or none at all in this situation. Seems ridiculous.

Along these lines, my follow up question is

if I am billing under my group NPI and my associate is IN Network with a plan but I am not, will the IN NETWORK fee get triggered? Trying to avoid a book keeping nightmare.