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National Association of Insurance Commissioners (NAIC): Professional or trade association for state departments of insurance (http://www.naic.org).

National Provider Identifier (NPI): This is an identifier assigned by the federal government to all providers considered to be HIPAA covered entities. Dentists who are not covered entities may elect to obtain an NPI at their discretion, or may be enumerated if required by a participating provider agreement with a third-party payer, or applicable state law/regulation.

An NPI is unique to an individual dentist or dental entity, and has no intrinsic meaning. There are two types of NPI available to dentists and dental practices:

Type 1 Individual Provider—A health care practitioner who is a single human being. ALL dentists are eligible to apply for Type 1 NPIs, regardless of whether they are covered by HIPAA.

Type 2 Organization Provider—A health care provider that is an organization, such as a group practice or corporation. Individual dentists who are incorporated may enumerate as Type 2 providers, in addition to being enumerated as a Type 1. All incorporated dental practices and group practices are eligible for enumeration as Type 2 providers.

On paper, there is no way to distinguish a Type 1 from a Type 2 in the absence of any associated data; they are identical in format. Additional information on NPI and enumeration can be obtained from the ADA’s Internet Web Site: http://www.ada.org/goto/npi.

necessary treatment: A necessary dental procedure or service as determined by a dentist, to either establish or maintain a patient’s oral health. Such determinations are based on the professional diagnostic judgment of the dentist, and the standards of care that prevail in the professional community.

non-autogenous: A graft from donor other than patient.

noncontributory program: A method of payment for group coverage in which the sponsor pays the entire monthly premium for the program.

non-covered charges: See covered charges.

nonduplication of benefits: Term used to describe one of the ways the secondary carrier may calculate its portion of the payment if a patient is covered by two benefit plans. The secondary carrier calculates what it would have paid if it were the primary plan and subtracts what the other plan paid. For example, if the primary carrier paid 80 percent, and the secondary carrier normally covers 80 percent as well, the secondary carrier would not make any additional payment. If the primary carrier paid 50 percent, however, the secondary carrier would pay up to 30 percent.

nonparticipating dentist: Any dentist who does not have a contractual agreement with a dental benefit organization to render dental care to members of a dental benefit program.

NPI: See National Provider Identifier.