Ken: Your comments are very helpful - thanks for writing in. And it's good to see even payers want a standard provider ID, rather than relying on proprietary schemes. Actually, our group is concerned mostly with the provider ID as used in the sender ID on the ISA, but the same issues probably arise for providers when they're forced to "memorize" a bunch of payer-assigned proprietary IDs to use within the application transaction set (in the NM1 and REF).
Is it safe to assume most payers assign proprietary IDs for each provider location? If so, that argues strongly for using the "DUNS+4" system, which can be used to uniquely identify specific locations within a particular company (provider, in our case). The DUNS (Data Universal Numbering System) number itself is assigned by Dun & Bradstreet, described at http://www.dnb.com/dunsno/dunsno.htm. Its advantage is that it's *free* - as a matter of fact, you actually have to work to avoid getting one of their numbers, as Dun & Bradstreet makes it their business to mind everyone else' business: practically every business in the U.S. has one, whether they want it or not. D&B assigns unique 9-digit DUNS numbers to all legal entities - it's a pretty safe bet that every clinic, hospital and practice in the U.S. has been enumerated by Dun & Bradstreet and has been assigned a DUNS number. For example, in my e-mail from Tuesday, I showed the DUNS numbers for two hospitals in my hometown, Columbus, Ohio: 04-643-0013 for Children's Hospital, and 07-164-3589 for Riverside Methodist. Its not even big regional hospitals who have DUNS numbers: even little Novannet has one - 07-293-0527. My doctor has one. My dentist has one. My kids' pediatrician has one. I assume anybody who does business has one. So the DUNS seems perfectly suitable as a unique provider ID - at least until the National Provider ID is implemented. Why do people fight it? On the other hand, DUNS+4 is probably a figment of some EDI guy's imagination. It's nothing but the DUNS appended with an additional 4 characters - hence the "+4" - defined by the company for their internal locations. The DUNS+4 is basically a unique "cookie" for identifying internal locations. A way was needed to describe retail store locations which would remain unique even with mergers and acquisitions - so the solution was to append a self-assigned 4-digit store (or dock or building) number to the D & B assigned DUNS. The DUNS+4 is used a lot in the grocery business: see how Krogers and SuperValu use the DUNS+4 to identify their warehouses and stores at http://edi.kroger.com/ and http://ec.supervalu.com/Wholesale/wholesale.htm. The 816 Organizational Relationships Transaction Set can be used to tell your trading partners (payers) which DUNS+4 corresponds to a particular (provider) location (e.g., address). You would think it would be sufficient for the provider to enumerate his own locations, assigning DUNS+4 IDs to each, and passing an 816 transaction set to the payer to update the payer's files. All payers would then be using the same provider location number (the provider-assigned DUNS+4), and we should all be happy! Another favorite of mine, the Health Industry Number (HIN), at http://www.hibcc.org/hin.htm, is an analogous attempt at coming up with a uniform method of assigning IDs to specific locations. One advantage of the HIN is that location information is centrally managed at HIBCC, so there's only one place you need to go to in order to obtain all HIN numbers (as opposed to receiving 816s from each provider individually). William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Fody, Kenneth W." <[EMAIL PROTECTED]> To: "WEDi/SNIP ID & Routing" <[EMAIL PROTECTED]> Sent: Wednesday, 27 March, 2002 11:03 AM Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? Bill: I can't speak for the other payors, but our Plan has been eager to see a national provider ID for some time now. We use multiple proprietary IDs and have wanted to consolidate onto one new number -- we even had a project to modify the provider ID fields in all of our systems. Unfortunately, the proposed National Provider ID has us afraid to re-enumerate providers on our own as we are sure the final Reg will come out the day after we are done, making us do it all over again. ;-) But seriously, multiple IDs is as much of a problem at our end as it is at the provider end. As for whether there is intelligence in the numbers, the answer is no and yes. The no is because there is no intelligence in the number itself. Rather the number is the intelligence. For example, if a provider has multiple locations, he or she will receive multiple ID numbers with each number corresponding to a location on our system. Because we started up new products in the mid-90's and took over an HMO at the same time, some providers received different ID numbers for different products. This is because those products or companies were supported on different systems than our traditional BCBS business, and those systems had different requirements for ID numbers. Regarding the information we will require on a claim, we will follow the same process as described by Doug Renshaw, except that we will not modify the NAIC numbers. Hope that helps. Ken Fody Independence Blue Cross
