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The Health Insurance Portability and Accountability Act (HIPAA) mandated
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 by the compliance
date of May 23, 2007, with a compliance date of May 23, 2008 for small
health plans.
On April 2, 2007 the Centers for Medicare & Medicaid Services (CMS) announced
that it is implementing a contingency plan for covered entities (other than small
health plans) who would not meet the May 23, 2007, deadline for compliance with
the National Provider Identifier (NPI) regulations under the Health Insurance
Portability and Accountability Act (HIPAA) of 1996. For a 12 month period after
the compliance date (i.e., through May 23, 2008), CMS did not impose penalties
on covered entities that deploy contingency plans.
UnitedHealthcare® National Accounts NPI Update:
- The NPI application period began on May 23, 2005. Click here for more information on the application process from the National Plan and Provider Enumeration System.
- UnitedHealthcare has taken the necessary precautions to ensure that systems are able to “process without disruption” if an electronic claim transaction is received with an NPI prior to the May 23, 2007 compliance date. This means that an NPI is disregarded if received on a transaction and the systems will continue to process the transaction based on the primary identifier.
- UnitedHealthcare began collecting NPI information in January 2006 and is storing it internally.
- UnitedHealthcare has the ability to download NPI data from the National Provider and Plan System (NPPES) into internal provider databases. This process was defined upon completion of the CMS “Data Dissemination” notice.
- To assist our trading partners, UnitedHealthcare developed companion documents to describe the company-specific details for HIPAA transactions, including the usage of NPI. The UnitedHealthcare National Accounts companion documents contain supplementary instructions to the HIPAA Implementation Guides. These companion documents do not replace or modify the HIPAA Implementation Guides, but should be used in conjunction with them (the HIPAA Implementation Guides can be found at www.wpc-edi.com).
- The National Uniform Claim Committee (NUCC) and the National Uniform Billing Committee (NUBC) have released modified versions of the current professional and facility claim forms. Among the changes will be the inclusion of NPI data fields. The revised claim forms and critical transition and effective dates are:
- As of May 23, 2008 all covered health care providers and organizations must obtain an NPI for identification purposes in standard electronic transactions.
- 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. - 04/25/07