The following NPI policy applies to UnitedHealthcare Services Inc. and its affiliates, however, the dates specified within the communication are specific to a majority of our systems where transactions arrive via UnitedHealthcare's common front end. Please refer to Appendix A for specific deliverable dates or details on variations in approach for UnitedHealthcare affiliates whose transactions do not come in via the common front end.
UnitedHealthcare has made a business decision to initially accept transactions sent to us without NPI or with incorrect NPI to ensure uninterrupted transaction processing to our physicians, health care professionals and organizations and avoid service issues for our customers. Furthermore, we will not reject transactions that contain other legacy identifiers in addition to NPI. We are considering a timeframe in which we will reject transactions that come in without NPI. Analysis of this timeframe will partially be based on how the overall industry implementation goes May 23, 2007 and after. Any changes to our current policy for accepting transactions without NPI will be preceded with communications to physicians, health care professionals, organizations and trading partners regarding the timeframe in which we expect to begin to reject HIPAA transactions that do not contain an NPI in the fields specified by the Implementation Guide.
UnitedHealthcare's Current NPI Policy for Trading Partners is as follows:
We will continue to process the HIPAA standard transactions regardless of whether or not NPI is present if it has enough information for us to process. This means we will not reject a transaction on the basis of missing or incorrect NPI unless we cannot process the transaction without this information.
We will not reject any HIPAA transactions because they contain both the NPI and the legacy identifier.
In most cases, outbound HIPAA transactions from UnitedHealthcare will include NPI information that was submitted on the inbound transaction. We will pass back the same NPI that was received. Clearinghouses and trading partners who send transactions with incorrect/invalid NPI to UnitedHealthcare must accept outbound transactions from UnitedHealthcare with the original NPI information transmitted. If no NPI was included in the inbound transaction, we will not return an NPI on the outbound transaction.
Due to potential physician/health care professional/organization and customer care issues, UnitedHealthcare has made the business decision to intake transactions without an NPI or with an invalid NPI. We request that clearinghouses and other trading partners follow this same process for UnitedHealthcare claims, unless it will cause issues with the clearinghouse's contractual agreement with its physicians, health care professionals and organizations. It will be acceptable for trading partners that have already implemented the Luhn check digit validation to leave the logic in place. For those trading partners who do not plan to implement the Luhn check digit, it is acceptable to not have the logic in place for UnitedHealthcare.
Clearinghouses and trading partners must ensure that outbound transactions from UnitedHealthcare that include information originally submitted by physicians, health care professionals or organizations are passed back through to appropriate physicians, health care professionals or organizations and vendors. We have surveyed our clearinghouses and trading partners and determined, based on the responses received, that there aren't any negative implications on their existing contractual agreements with physicians, health care professionals or organizations as a result of passing back the information that was orginally submitted.
For additional information on specific NPI requirements for UnitedHealthcare and each of our affiliates, please refer to the companion documents listed within Appendix B.
