William, [Incidentally, the first two times I hit "Reply", Outlook Express chose to "Send" something instead, so I hope you like spam. . . .]
I didn't realize that I had "volunteered" to "cochair" anything in Seattle until I got back home and read the flip charts more carefully. I just meant to be on an "interested party that hopes to be helpful" list. On a practical level, though, I'm finding the Business Issues cochair duties considerably more demanding than expected, and that will probably limit my participation in all of my White Paper Authoring Groups (WPAGs) (IG Choice, Contingency Planning, and Routing, to name the ones that I can still remember). . But I agree that the Routing group, for practical reasons, will need to focus on only those aspects of the existing and pending national identifiers that affect the routing in some way. And, as I've noted earlier, WEDI (not WEDI SNIP) already has a Policy Advisory Group (PAG) for the national identifiers. SNIP may create related groups once one or more of the final rules is published, but probably not before then. We might even form a separate Workgroup (WG) for this purpose, although I would probably prefer that we either have a separate subworkgroup (SWG) for each identifier within the current Transactions WG or a single Identifiers SWG within that WG. These are just my thoughts, though, and not policy statements, of course. As to the other matters under discussion: (1) I agree that the switch in focus from a "National Payer ID" to a "Health Plan ID" came as a bit of a surprise, and was reportedly inferred as necessary after a careful HHS legal analysis of the legislative language. And that takes us from thousands of "payers" to several million "plans". Maybe there is something about "unintended consequences" here. I guess we can rely on the law for a definition of a "health plan", but I'm not sure how we should define "payer" as distinct from the health plan. And I'm supposed to know things like that. (2) As regards the current multiplicity of provider IDs, I am aware of a case where one "provider" (a medical center) has about 30 IDs for one payer, with about 25 of those sharing the same street address. And the same payer sometimes has different contractual relationships with a given provider depending on the procedure code used, even when the same person and location is involved, so teasing out the relationship of a transmission to a contract should be a lot of fun, whoever's scope that falls under. ----- Original Message ----- From: "William J. Kammerer" <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Monday, February 18, 2002 5:36 AM Subject: Re: Number of IDs assigned to a provider: Time-out for scope discussion!! > 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 gritty 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
