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National Provider Identifier (NPI)

The National Provider Identifier (NPI) is the 10-digit identification number issued to providers by the Centers for Medicare and Medicaid Services (CMS).  The Administrative Simplification portion of the Health Insurance Portability and Accountability Act (HIPAA) mandated the transition from Unique Provider Identifiers (UPINs) to NPIs.

 

Three Ways to Apply for Your NPI

  1. Apply online at the National Plan and Provider Enumeration System (NPPES) Web site . You should receive your NPI via e-mail in about 20 minutes.
  2. Call the NPI Enumerator at 800-465-3203 for a paper application. You should receive your NPI in the mail within 6-8 weeks.
  3. Use Electronic File Interchange, also called "Bulk Enumeration," to apply for multiple NPIs at once and reduce your administrative burden.

Updating Your NPI

Wellmark requires an NPI for all claims. Wellmark validates the NPI by comparing:

  • The billing and rendering provider numbers
  • The first date of service or admit date
  • The provider tax identification number (TIN)

Wellmark rejects claims that don't match the NPI information captured during the provider enrollment process.

 

If your NPI changes, notify Wellmark using our online form to ensure more timely and accurate claims processing.

 

Blue DentalSM Claims

To report your NPI to Blue Dental, please call 877-258-3685 or 515-558-7744.

 

When someone in the member’s family has other dental coverage, send the claim for service to both the primary and secondary insurance plans. Blue Dental will coordinate benefits if a member has coverage under more than one dental plan.

 

Medicare Crossover Claims

Medicare claims that cross over to a secondary payer report the National Provider Identifier (NPI) only as the provider identifier.

 

If Wellmark cannot verify your NPI:

  • Claim payments for Medigap (e.g., Senior Blue® or MedicareBlue SupplementSM) members will be processed with a default provider number. Wellmark will issue a separate check for each claim processed.
  • Claim payments for Medicare “Carveout” (e.g., employer group coverage) and Federal Employee Program members may be delayed as Wellmark attempts to identify the provider on the claim. If we cannot identify the provider, the claim may be rejected.

Please Note: Adjusted Medicare claims will not cross over to a secondary payer if the original claim was submitted to Medicare without a valid NPI.



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