Humana's Your Practice

Humana to Begin Receiving National Provider Identifiers

During the third quarter of 2006, providers in the Humana network will start using a new identifier. The mandated use of the National Provider Identifiers (NPIs) is part of the Health Insurance Portability and Accountability Act (HIPAA), and will result in a national standard identifier for health care providers.

The NPI is a 10-digit number assigned by a CMS-funded NPI Enumerator, Fox Systems, Inc., through the National Provider and Plan Enumerator Systems (NPPES). It contains no embedded information about the health care provider, such as the type of health care provider or the state in which the provider is located.

Humana will continue to receive tax identification numbers or legacy identifiers (Humana provider I.D. numbers physicians currently use when filing claims) until this new procedure is in place.

Health care providers are accustomed to using multiple identification numbers from different health plans. HIPAA mandated the creation of a unique NPI for each health care provider that must be used by all health plans.

All health care providers and provider plans will be required to use the new NPIs by May 23, 2007.

This new identifier will replace many existing national (e.g., UPIN), state (e.g., Medicaid) and proprietary (e.g., individual hospital, health care systems and commercial payers) provider identifiers. NPIs will simplify electronic transmission of HIPAA standard transactions and provide a more streamlined coordination of benefit transactions between health care providers and Humana. The NPI will not replace provider tax I.D.s or the Drug Enforcement Administration (DEA) numbers. Payment for providers will still be based on the tax I.D. number. For more information on NPIs, providers should visit the Department of Health and Human Services Web site at www.cms.hhs.gov/NationalProvIdentStand/.

All health care providers and provider plans will be required to use the new NPIs by May 23, 2007, on all HIPAA electronic transactions and are encouraged to use it on paper claims also. The new HCFA 1500 forms will have fields specifically for the NPI. Humana is implementing the use of NPIs earlier in order to work through any issues that may arise involving the new identifiers. This will be the dual identifier period scheduled to begin on October 20, 2006.

Humana and other third parties will need NPIs for many transactions, including referrals and prescriptions, so providers should apply for an NPI even if their group does not send electronic transactions. For information on obtaining an NPI, providers should visit www.foxsys.com. Providers can apply for an NPI over the Web or by calling the NPI customer service center at (800) 465-3203.

For more information on Humana’s use of NPIs, visit www.humana.com and choose “Providers” and then “Provider Resource Center.” Click on “Provider Tools” and then scroll down to “National Provider Identifier (NPI).”