Join our network

Apply online

How will you file your claims to Humana?

Please enter this information exactly as it appears on your federal income tax return.
Required Required

Business address

National Provider Identification Number

Enter the billing National Provider Identification Number (NPI) associated with your SSN.

The NPI is a unique identifier for covered health care providers adopted as part of the Health Insurance Portability and Accountability Act.

W-9 Certification

By entering my name below, under penalty of perjury, I certify the following (For more information, view W-9 certification instructions )
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for my number to be issued)

Required 2. Am I subject to backup withholding?

I am not subject to backup withholding because:

(a) I am exempt from backup withholding,

or

(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends,

or

(c) The IRS has notified me that I am no longer subject to backup withholding

3. I am a U.S. citizen or other U.S. person
Please enter your name to certify the above.

Contract contact address

Humana may need to contact you regarding your application for a network participation agreement.Please enter the following information for the person who has the responsibility for contract related issues.

By clicking “Next,” I agree that the above information is correct and I understand and agree to the Humana Privacy Policy (opens in new window) 
Please enter this information exactly as it appears on your federal income tax return, to help us validate your identity for contracting purposes.
Required Required

The Employer Identification Number and Taxpayer Identification Number are used to identify business entities for tax and identification purposes.

Business name

A trade name or “doing business as” name is the name you choose for your business that is different from your personal name, the names of your partners or the officially registered name of your company.

An exempt payee is an individual or group that receives income for which backup withholding is not required. Anyone who is tax exempt must complete a W-9 form.
Select your Exempt payee code and/or Foreign Account Tax Compliance Act (FATCA) exemption code.
(For more information, view W-9 certification instructions )

The codes on a W-9 form that identify types of payees who are exempt from backup withholding.
and/or

The codes on a W-9 form identifying payees who maintain financial assets outside of the United States but are exempt from reporting those assets.

Business address

National Provider Identification Number (NPI)

Enter the billing National Provider Identification Number (NPI) associated with your EIN/TIN.

The NPI is a unique identifier for covered health care providers adopted as part of the Health Insurance Portability and Accountability Act.

W-9 Certification

By entering my name below, under penalty of perjury, I certify the following (For more information, view W-9 certification instructions )
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for my number to be issued)

Required 2. Am I subject to backup withholding?

I am not subject to backup withholding because:

(a) I am exempt from backup withholding,

or

(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends,

or

(c) The IRS has notified me that I am no longer subject to backup withholding

3. I am a U.S. citizen or other U.S. person

4. The FATCA code entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Please enter your name to certify the above.

Contract contact address

Humana may need to contact you regarding your application for a network participation agreement.Please enter the following information for the person who has the responsibility for contract related issues.

By clicking “Next,” I agree that the above information is correct and I understand and agree to the Humana Privacy Policy (opens in new window)