The National Provider ID (NPI) registrar will certainly not be assigning IDs to providers based on "contract" number, so it's clear that payers will already have to be working on separating the notion of contract from that of provider ID in their HIPAA remediation efforts. So whether payers used the NPI, D-U-N-S, DUNS+4, HIN, or Federal Tax ID to identify providers, assignment of these IDs will necessarily be based on licensed entity, individual, location or role - but never on the contract with the particular payer.
Nonetheless, even though we're sometimes forced to discuss the general notion of IDs as used in the application transaction sets, our primary problem to solve is getting some consistent way of identifying providers as EDI participants - and getting everyone (including payers) to use that same ID for looking up providers' EDI addresses (inter alia) in the Healthcare registry. It will be a great step forward if our small group gets all players singing from the same hymnal as far as ISA identification goes; it would be icing on the cake, indeed, if interim application solutions to the lack of an NPI came out of our group, too! It sounds like we're coming to some sort of agreement that not only providers, but payers, too, find it cumbersome to deal with proprietary payer-assigned IDs as EDI Identifiers on the ISA. Are we getting closer to being able to make some definitive statement whereby we recommend that all providers' (or their agents') EDI portals be identified by DUNS, DUNS+4, HIN or Tax ID (the only current relevant choices in the Interchange ID Qualifier)? William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Dave Minch" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, 28 March, 2002 12:43 PM Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? William, There is really no discernable pattern to when a provider gets assigned a unique identifier, but physical location does not appear to have anything to do with it -- it usually is more a matter of what plans a provider participates in (e.g. a few payers assign different provider numbers based on plan participation). In the predominance of cases, however, the provider number distinction is made based on licensed entity. Our MMG provider group, for example, does business from many physical locations, and has multiple provider numbers, but usually only one number per carrier (except where they participate in multiple plans, and the carrier assigns based on plan). On the other hand, it is a certainty that each of our 16 licensed entities has a unique provider number for any given carrier. Dave Minch T&CS Project Manager John Muir / Mt. Diablo Health System Walnut Creek, CA (925) 941-2240
