I think you are seeing Congressional intent clashing with reality. It is not talked about too much fraud was one of the many issues in the early discussions concerning HIPAA legislation. It was thought if providers had a unique id it would be easier to find patterns of abuse. The reality being the need for plan ids given how the healthcare system currently works. Regards,
David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 -----Original Message----- From: Kepa Zubeldia [mailto:[EMAIL PROTECTED]] Sent: Monday, February 18, 2002 8:45 PM To: [EMAIL PROTECTED] Cc: William J. Kammerer; 'WEDi/SNIP ID & Routing' Subject: Re: Number of IDs assigned to a provider: Time-out for scope Chris, For several years HCFA had been working on "payerID". Then HIPAA specified Plan ID in the law. That is one of the reasons why the regulations have not come out yet. It took a while to figure out how the Plan ID, which is what the HIPAA law specifies, relates to the payerID, which is what everybody wants. Kepa Christopher J. Feahr, OD wrote: > In my view, the core problem being considered by our group is the > addressing/routing of transactions. Since transactions only move around > as parts of interchanges, we will necessarily have to consider > routing/addressing at the interchange level, but I would argue strongly > against limiting this discussion, per se, to the ISA receiver field. > > PlanID: I guess I missed the govt's shift from wanting a national ID# > for payor-entities to them now wanting a national ID# for the "plans". > Besides my objection to adding more "intelligence" than needed to the > payor's ID number, isn't the "plan" or "line of business" sufficiently > identified by the situational SBR03 and 04 segments (plan number and > plan name)? Can't a payor simply assign a "plan number" that's unique > within his organization, and then print that on the subscriber's ID card > along with a nationally-unique PayorID? In fact, this would seem to be > the obvious resolution to the "VDT" plan confusion that I mentioned in > my other post (I'm still learning what's in the 837!). > > How set in stone is this "national planID" concept? > > Back to "scope": > One way for the Little Provider to simplify his addressing/routing life > would be to send only one kind of "thing" in each interchange, allowing > his/her transaction-addressing to essentially be accomplished in the > ISA... and allowing this group to focus on the ISA receiver without > ignoring the LP's need to discover the ultimate target address for the > transaction. Is this a reasonable "best practice" recommendation for a > "small provider"? > > -Chris > > > At 10:36 AM 2/18/02 -0500, William J. Kammerer wrote: > >> Part of any disagreement [on the scope of Identifier discussion] may be >> due to confusion (on my part) with the charter of the Identifiers >> Subgroup (the "ID" of WEDi/SNIP ID & Routing) - not an easy confession >> to make considering I got "volunteered" to be a co-chair of the >> sub-group at the Seattle meeting, along with Zon Owen! >> >> I may have been asleep at the wheel, and didn't really notice that the >> scope of the Identifiers subgroup seems much larger than I originally >> thought. The 6010 Project Organization paper shows this subgroup will >> >> "...write implementation guidelines for use of identifiers >> in standard EDI transactions. It will address the problems >> for implementation prior to the introduction of national >> standard identifiers, entities potentially not included in >> the national identifier programs, transition to national >> identifiers, and use of national identifiers." >> >> This seems like an overly broad mission, especially since we're mostly >> concerned with interoperable guidelines for "discovering" EDI addresses >> to use in the routing of standard EDI transactions. Reading the >> Identifiers subgroup's scope, I'm not surprised people would think we're >> going to get into the nitty grittty of using identifiers for providers, >> payers and contracts within application transaction sets! I have no >> objection to looking at this interesting problem or writing it up in our >> white paper (which would consist of just copying and pasting from Kepa's >> Identifier myths), but this is really a topic better served by the >> overall WEDi/SNIP Business Issues SWG. >> >> If there's no strong objection, Peter Barry and I advocate restricting >> the scope of the Identifiers sub-group to investigating identifiers "as >> they're used to assist in the routing of standard transactions - i.e., >> when they're used in the ISA receiver field." One scenario, relevant to >> Peter's other work, is how the provider will use the number on the >> patient's insurance card to "discover" the EDI address of the payer to >> whom claims and eligibility requests should be sent. The insurance card >> will contain the card issuer number which includes the (National) plan >> ID; using our recommendations, this Plan ID would be the key to >> searching for the EDI address(es) of the ultimate payer (or CH or >> repricer). >> >> As it is - even without "mission creep" in the Identifiers subgroup - >> we're still probably stepping on the toes of other workgroups within >> AFEHCT-WEDI Health Care Communications Security and Interoperability >> project (in the areas of security and packaging interchanges). Peter >> Barry sent out an announcement Friday re: the AFEHCT-WEDI >> Interoperability effort; the listserv for the AFEHCT-WEDI project is now >> set up. If you would like to join its listserv, go to www.afehct.org, >> and follow the instructions to join the "Interop" listserv. After this >> new AFEHCT-WEDI project starts up, it will be easier to coordinate and >> "liaise" with them. See Document 1100 Project Organization at the >> WEDi/SNIP ID & Routing web page at http://www.novannet.com/wedi/. >> >> William J. Kammerer >> Novannet, LLC. >> +1 (614) 487-0320 >> >> ----- Original Message ----- >> From: "Rachel Foerster" <[EMAIL PROTECTED]> >> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> >> Sent: Sunday, 17 February, 2002 02:29 PM >> Subject: RE: Number of IDs assigned to a provider >> >> >> 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 > > > Christopher J. Feahr, OD > http://visiondatastandard.org > [EMAIL PROTECTED] > Cell/Pager: 707-529-2268
