National Provider Identification (NPI)

The Health Insurance Portability and Accountability Act (HIPAA), federal Medicare regulations, and many state Medicaid agencies mandate the adoption and use of a standardized National Provider Identifier (NPI) for all health care
professionals.  In compliance with HIPAA, all covered health care providers and organizations must obtain an NPI for identification purposes in standard electronic transactions. In addition, based on state specific regulations NPI may be required to be submitted on paper claims. HIPAA defines a covered health care provider as any provider who transmits health information in electronic form in connection with a transaction for which standards have been adopted.

These covered health care providers must obtain an NPI and use this number in all HIPAA transactions, in accordance with the instructions in the Implementation Guides.

•     To avoid payment delays or denials, UnitedHealthcare requires a valid Billing NPI and Taxonomy Code(s) be submitted on both paper and electronic claims. In addition, UnitedHealthcare strongly encourages the submission of
all other NPIs as defined below.

•     It is important that, in addition to the NPI, you continue to submit your Tax Identification Number (TIN).

The NPI information that you report to us now and on all future claims is essential in allowing us to efficiently process claims and to avoid delays or denials.

How to submit NPI, TIN and taxonomy on a claim

The information below provides the location for NPI, TIN and Taxonomy on paper and electronic claims. See definitions in the UB-04 Data Specifications Manual.

HIPAA 837P (Professional) Claim Transaction

Primary Identifier                          Loop 2010AA, NM109
Pay-To Provider Federal Tax ID Loop 2010AB, NM109
Referring Physician Loop 2310A, NM109
Rendering Physician Loop 2420A, NM109

CMS 1500 (08-05) Professional Claim Form

Referring Provider NPI Field 17b
Rendering Provider NPI Field 24j
Service Facility Location NPI Field 32a
Billing Provider NPI Field 33a