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HIPAA mandates the adoption and use of a standard identifier called the National Provider Identifier (NPI) for all health care providers to be used in electronic transactions. NPI is required on paper transactions only in those states where this is mandated, such as Minnesota. This standard identifier replaced the current Medicare identifiers (UPIN and OSCAR numbers) and Health Plan proprietary provider numbers for standard EDI transactions. HIPAA requires that covered entities (i.e., health plans, health care clearinghouses, pharmacies, and health care providers) that transmit any health information in an electronic HIPAA format, use NPI in transactions. UnitedHealthcare has the ability to download NPI data from the National Provider and Plan System (NPPES) into internal provider databases. Go to the National Plan and Provider Enumeration System site for more information.
To assist our EDI trading partners, UnitedHealthcare developed companion documents to describe the company-specific details for HIPAA transactions, including the usage of NPI. They contain supplementary instructions to the HIPAA Implementation Guides and do not replace or modify the HIPAA Implementation Guides, but should be used in conjunction with them.
To avoid payment delays or denials please include a valid NPI on all Medicare and Medicaid claims submitted to UnitedHealthcare including SecureHorizons®, Evercare® and AmeriChoice®, for processing. A valid NPI is required for all covered claims.
It is important that in addition to the NPI you continue to submit your Tax Identification Number (TIN) on all electronic and paper professional medical claims.
Please continue to submit complete claims to comply with complete claim billing requirements as published in the UnitedHealthcare Administrative Guide. The NPI information that you report to us now and on all future claims is essential in allowing us to efficiently process claims. View How to Submit NPI, TIN and Taxonomy on Paper and Electronic Claims
For more information:
UnitedHealthcare National Provider Identifier Site
Related Links:
Centers for Medicare & Medicaid Services NPI Site
This material is provided on the recipient's agreement that it will only be used for the purpose of describing UnitedHealthcare National Accounts products and services to the recipient. Any other use, copying or distribution without the express written permission of UUnitedHealthcare National Accounts is prohibited. - 02/25/11