The Health Insurance Portability and Accountability Act (HIPAA) mandates the adoption and use of a standard identifier called the National Provider Identifier (NPI) for all health care providers considered a 'covered entity' or 'covered health care provider' to be used in HIPAA standard electronic transactions.
- A 'covered entity' is defined as a health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in connection with a HIPAA transaction.
- A 'covered health care provider' is a person or organization providing medical and health services, and bills, or is paid for health care in the normal course of business. All covered health care providers must be enumerated as stated in regulation 160.103 (CFR Part 45).
HIPAA regulations require the submission of NPI on UB-04 and CMS 1500 (02/12) paper and HIPAA 837 electronic claim submissions. UnitedHealthcare and its Affiliates require the submission of NPI on all paper and electronic claim submissions, and in addition, require the submission of the Billing Provider Tax Identification Number (TIN) and Health Care Provider (NUCC) Taxonomy Codes in order to ensure claim reimbursement.
The links below will provide information on how to submit your NPI to UnitedHealthcare, and tips for submitting NPI, Tax Identification Number (TIN) and Health Care Taxonomy Codes on paper and electronic claim submissions:
UnitedHealthcare and its Affiliates also require the use of NPI to identify providers in all HIPAA adopted standard transactions. For additional information on specific NPI requirements, please refer to UnitedHealthcare's HIPAA electronic transaction Companion Documents, to be used in conjunction with the HIPAA Implementation Guides.
Any changes to our NPI policy will be preceded with communications to physicians, health care professionals, organizations and trading partners. Such communications will express when we will reserve the right to no longer accept HIPAA transactions which do not contain a valid NPI in the fields specified by our HIPAA-adopted implementation guides.