NPI & Payer Codes

National Provider Identifier (NPI) Requirement

Your National Provider Identifier (NPI) must be used to identify your practice when submitting claims.

Your billing and rendering National Provider Identifier (NPI) numbers must be registered with CareFirst and must exactly match the information listed in our provider files.

The billing NPI, or group NPI, identifies the entity or group responsible for submitting the claim and receiving payment, while the rendering NPI, or individual NPI, refers to the individual healthcare provider who performed the service. If either your NPI or your Tax Identification Number (TIN) is missing or does not match our records, your claims may be delayed or rejected.

On an ADA dental claim form, the billing NPI should be entered in the section designated for the "Billing Dentist or Dental Entity," typically found in the lower portion of the form, while the rendering NPI is placed in the "Treating Dentist and Treatment Location Information" section. Make sure to accurately complete both fields, as this ensures proper identification and processing of your claim.

Additionally, the three-letter prefix that precedes the member identification number must be included on all electronic claim submissions. This prefix helps route the claim correctly and should be entered in the appropriate member ID section of the claim form.

Need an NPI?

Apply through the National Plan and Provider Enumeration System (NPPES). Once you receive your NPI, you will need to submit it to CareFirst on the NPI Submission Form for Dental Providers.

Payer Codes

CareFirst's payer ID code for dental electronic claims is 00580.