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National Provider Identifier Requirements

Effective May 23, 2008, Federal Regulations Require:

  • All institutional and professional claims submitted electronically must contain the National Provider Identifier (NPI) of the billing provider and the attending/rendering physician. The NPI of the referring physician is also recommended.
  • The billing provider's Federal tax identification number continues to be required on all claims. Claims which do not contain this information may be rejected back to the provider.

American Family Mutual Insurance Company does not require the NPI on paper claims, although this information is helpful in the processing of the claim. Some provider networks do require the NPI on paper submissions and will reject claims which do not contain this information.

We recommend that all providers review the NPI requirements of the networks in which they participate. Paper claims should be submitted on the most recently revised claim forms (CMS 1500 version 08/2005 and UB-04).