NPI

National Provider Identifier (NPI)

The NPI is a unique 10-digit numeric identifier used to identify health care providers and organizations. Its use is a requirement of the Health Insurance Portability and Accountability Act (HIPAA).

Electronic transaction requirement

Humana enforces the HIPAA requirement to use an NPI on standard electronic transactions. Claims (HIPAA 837 I, P and D) must contain an NPI, or they will be rejected by the clearinghouses with which Humana has contracted.

Legacy identifiers such as UPINs, state license IDs, etc., are no longer allowed on claim submissions. Including these identifiers may cause your claims to be rejected. Please check with your vendors to ensure these are not being submitted on your electronic claims.

For health care providers receiving electronic remittance advice (HIPAA 835 ERA), Humana includes the submitted NPI with the ERA data after the claim has been adjudicated.

In the spirit of administrative simplification and in conjunction with CMS recommendations, health care providers submitting paper claims are strongly encouraged to use their NPI. Submitting paper claims without the NPI may cause a delay in claims processing.

For more information, review these frequently asked questions (153 Kb) or visit this CMS website (link opens in new window) .