I'm not sure that I agree at all with the assertion below that "identifiers are of interest .... only as they may be used in the ISA sender/receiver fields."
I'd much prefer to get feedback from payers and providers on what their needs are on this issue....especially in light of the fact that it appears that it's not at all uncommon for a provider to have to send a claim to a payer selecting from more than a single address. What's the sentiment from the payers and providers (I do hope there are a few!) on this list? Is there consensus to limit the scope of the discussion of identifiers - issues, challenges, needs/requirements - to only the ISA segment? Rachel Foerster Rachel Foerster & Associates, Ltd. Phone: 847-872-8070 -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 17, 2002 11:46 AM To: WEDi/SNIP ID & Routing Subject: Re: Number of IDs assigned to a provider One reason Kepa appears to be such a prolific writer is that he keeps on re-using the same old (but good) stuff - cutting and pasting from here to there. So, without his permission, I'm reproducing his Identifier Myths #47 through 49, from last summer on HIPAAlive, which give more background on the "Multiple Personality Disorder." See the WEDi/SNIP ID & Routing web page at http://www.novannet.com/wedi/ - look for "Kepa's Identifier Myths #47 - #49." Identifiers are of interest to us here in the WEDi/SNIP ID & Routing group only insofar as they're used to assist in the routing of standard transactions - i.e., when they're used in the ISA receiver field. The MPD only affects identification of the provider (and the contract) in the claims ensconced within the X12 transaction. I have not seen any convincing evidence that a provider needs (or wants) multiple IDs to identify his "EDI Server" or "front door" or "inbox" (to use Chris Feahr's terms). As a matter of fact, I can easily imagine a single 837 containing claims (intended for a particular payer) which pertain to any number of contracts or provider IDs - which one do you use for the provider's ISA EDI Identifier used in the ISA? Remember: it has to be one of the ID domains allowed by the HIPAA IGs, which kind of boils down to the DUNS, HIN or EIN for providers. Payers already seem to know the providers' EINs - certainly those could be used. There's no reason for a provider to have to define a multitude of EDI addresses for each payer-proprietary provider no. combination - for most providers, indeed, all EDI will end up at the same "front door." Let's not solve OPPP (other people's programming problems). William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "WEDi SNIP 4 (E-mail 3)" <[EMAIL PROTECTED]> Sent: Saturday, 16 February, 2002 07:42 PM Subject: FW: Number of IDs assigned to a provider Kepa, Thanks for this perspective. Given that this work group is supposed to focus on both identifiers and EDI addresses - and it's not outside the realm of reality that a different EDI address must be used for the same payer by the same provider but using different provider ID's - this scenario must be taken into consideration as the specifications are developed. Rachel -----Original Message----- From: Kepa Zubeldia [mailto:[EMAIL PROTECTED]] Sent: Saturday, February 16, 2002 1:02 PM To: [EMAIL PROTECTED] Subject: Re: Number of IDs assigned to a provider Rachel, You can post it any time. There are a couple of reasons for the multiple identifiers. The first reason is that each payer has no way of discovering what the provider IDs are. You can't just go to a central location (IRS or HHS or something else) and ask for the ID for Dr. Jones. So, as a path of least resistance the payer issues its own identifier to Dr. Jones. The second common reason is to distinguish the multiple contracts that Dr. Jones has with the same plan. If Dr. Jones has a rural clinic and a downtown clinic, with different contracted rates, the health plan wants Dr. Jones to use a different ID to indicate which contract applies in each case. And they don't need to have two physical locations. Some times the same doctor in the same location has different contracts. This second problem is not solved with a centralized registry, but could be solved by indicating the contract in the 837. This is already contemplated in the HIPAA implementation guides. There is no reason why the contract must be "encoded" into the provider identifier itself. At least not under HIPAA. I hope this helps. Kepa Rachel Foerster wrote: > Kepa, > > Given this fact, then I believe it's even more essential that the issue of > identifiers (use/role/determining - linking to the correct EDI address) be > an integral part of the whole effort to develop specifications for an EDI > Addressing system. Furthermore, I'm beginning to believe that the issue of > identifiers should **not** be decoupled from EDI Addresses. > > I don't think this will be a trivial effort. Right now the discussion on the > routing list seems more focused on the technical aspects of a domain name > server rather than focusing first on what the overall requirements should > be, including this challenge of how the provider can link one of the many > identifiers assigned to him/her to the appropriate EDI address for a given > payer/plan. It seems to me that we have a many-to-many situation, which can > become quite complex....especially if this address discovery plus linkage > needs to be done dynamically at run time. > > With your permission, I'd like to post this message exchange to the list. > > Rachel
