Jan's e-mail re: the NPI and the Provider Taxonomy Code is at http://www.mail-archive.com/transactions%40wedi.org/msg00706.html. It's indeed relevant to our late discussion whereby identification of providers should not be conflated with payer contracts - nor the provider specialty. Thanks for reminding us of this great posting, Rachel.
As I indicated in my last e-mail, I acknowledged that "detailed discussion of various identifiers and identification systems" might be a little off track (because they're mostly relevant to the application transaction sets): as always, "[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." Even before the NPI comes into being, I would hope we can get away from proprietary payer-assigned provider identifiers in the ISA. Then we can seriously consider removing the ZZ (Mutually Defined) option in the Interchange ID Qualifier. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Thursday, 28 March, 2002 04:15 PM Subject: What's the focus? The issue that Williams touches on in the first paragraph below was intended, I believe, to be addressed by the use of the Provider Taxonomy Code such that a provider would have only one provider ID, but would use the taxonomy code to specify a specialty, etc. that the payer would then use in combination with the provider ID during its adjudication process. Jan Root posted an excellent description of this original intent of the Provider Taxonomy Code on another list, but unfortunately, I'm not able to locate it quickly. If Jan is on this list, perhaps she could re-post her description here as well. It seems to me that a key goal is to determine how an identifier (whether the provider's, payer's, clearinghouse's, or whatever) appearing in the ISA Sender or Receiver ID field could be used to then discover more complete information about that entity's EDI addressing requirements...plus potentially other information about connectivity as well. Today the HIPAA IG's specify what coding systems are valid for use within the ISA in HIPAA-Land: 01 Duns (Dun & Bradstreet) 14 Duns Plus Suffix 20 Health Industry Number (HIN) 27 Carrier Identification Number as assigned by Health Care Financing Administration (HCFA) 28 Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration (HCFA) 29 Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration (HCFA) 30 U.S. Federal Tax Identification Number 33 National Association of Insurance Commissioners Company Code (NAIC) ZZ Mutually Defined (Just a side note to the discussion of the DUNS+4 topic: The +4 suffix is not an official component of the DUNS assigned by D&B....it's determined by the entity that the DUNS identifies. Thus, there is no standardization to the +4 suffix. I would urge caution here is getting too enamored of the DUNS+4.) In the absence of the national identifiers, we are left to select from one of these coding systems or to use the ZZ Mutually Defined. It's my opinion that if the objective is to be able to use the identifier from the ISA to discover more detailed EDI addressing information, then it's irrelevant which coding system the ISA identifiers are based on. The only requirement at the present time is that to be compliant with the HIPAA specifications, one must choose one of the above. Thus, I'm not sure that I understand the detailed discussion of various identifiers and identification systems. Wouldn't it be more on point to be examining how the ISA identifier would/could/should be used to link to the EDI Addressing information? Furthermore, when (notice that I'm the eternal optimist and didn't say if) the national identifiers are finalized, then I would certainly expect that the ZZ Mutually Defined option would go away....and even perhaps the other choices in favor of the national identifiers. Thus, I again reiterate that I think it's quite irrelevant to the goal of this work group to get too wrapped around the axle about various identification systems. Rather, shouldn't the focus be on the "functional use" of the identifier in the ISA as the key to discovering the detailed EDI addressing information? Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http:/www.rfa-edi.com -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Thursday, March 28, 2002 2:43 PM To: WEDi/SNIP ID & Routing Subject: Re: Payers sure do like proprietary provider IDs! Do providers feel the same way? 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.
