Re: Payers sure do like proprietary provider IDs! Do providers feel the same way?
The ISA receiver ID is defined as follows in the IG: "Identification code published by the receiver of the data; When sending, it is used by the sender as their sending ID, thus other parties sending to them will use this as a receiving ID to route data to them" The definition seems to imply that ISA08 is some sort of an "EDI address". But even if you can identify the receiving entity with one of the permitted numbers, it is still likely to have a variety of application-specific or possibly sender-specific EDI addresses... that might change over time. Can interchanges be going out the door with identical ISA08 values (identifying the receiver), but be going to different EDI addresses... because of their specific transaction payloads? With only 15 characters in the receiver ID, I don't see how we can identify the entity (via DUNS, FEIN, etc.) and have enough room left to fully specify even a unique registry-pointer to the rest of the "collaboration" details. This fuzziness about what the standard requires in ISA identifiers, combined with the "creative" uses that Michael Mattias has described is making it hard for me to visualize how anyone could route these messages WITHOUT drilling down into the transactions to get information about the true communicating parties. I'm beginning to think that there may not be enough intelligence in the ISA/ISE envelope to route these things. Either the current (several week long) trading partner negotiation and testing process would have to take place for every messaging-entity-pair, or we would have to implement something like the full-bore ebXML CPP/CPA for fully automatic negotiation. In that case, we could use the ebXML transport protocol to carry the X12 interchange as a "dumb" payload... rendering the ISA identifier unimportant. Does it still seem feasible to the group to have hundreds of thousands of communicating parties trying to route these messages on the basis of a 15 character ISA identifier? -Chris At 04:40 PM 3/29/02 -0500, William J. Kammerer wrote: >Keep in mind that if the Registry is powerful enough to be searched by >any (non-proprietary) ID, then the sender could just blindly stick the >FEIN in the ISA receiver ID, knowing full well that a VAN or CH >intermediary could search the Registry for the CPP which contains the >EDI addresses and ports. The whole concept of a "preferred" ID may give >way to a more powerful notion whereby a receiver can be identified in >the ISA by any of its known IDs (whose domains or type are allowed by >the HIPAA IG). Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
Re: Payers sure do like proprietary provider IDs! Do providers feel the same way?
If I may chime in Methinks we are confusing the two SEPARATE identifiers of 'EDI Address' and 'Provider ID.' The EDI Address is (should be) there to make sure the data get to the correct party and is (should be) independent of application. In a 'healthcare' context: the proposed NPI is (should be) totally irrelevant to EDI Address and/or "discovery of capabilities." On the other hand, "Provider ID" is used by the payer-provider partnership for applications purposes; here the proposed NPI is absolutely relevant. As I stated in an earlier post: there are a lot of current EDI users who have abused the ISA identifiers (EDI addresses) so that their in-house applications do not have to work so hard to figure out who the _applications_ partner really is. Unfortunately, a lot of small and not-so-small H/C software firms thought they understood EDI and did some cute hard-coded assumptions (e.g., ISA06=GS02=ProviderID). Sheesh, who lets these people claim EDI expertise, anyway? Payers (and other large non-healthcare users) haven't helped either, many asking for a different ISA receiver IDs depending on the "type of applications information" contained in an inbound interchange. Even the HIPAA-compliant specs kind of toy with this, restricting the number of different types of functional groups (and therefore, documents) permitted in a single interchange. As an applications developer, I have identified a need for both identifier items, although they are tied together in Real World Applications: 1. I need to query "something" to get an electronic address for an entity so I can 2. Electronically ask that entity (or his agent) for his specific electronic capabilities and rules. While a single location (a registry) for both would be nice (not necessarily superior, but more convenient) , I'd be scared to death it could not or would not be maintained and thus rendered less than useless. BTW, Mr K, thanks for the link to Ms. F's post on ebxml CPPA... I followed her link (since changed, but you can get there from the suggested ebXML 'home' page easily enough) and now I have a little reading to do ... (Although IE 5.0 won't read that ebXML, I have a couple of XML parsers here and if one of them don't work 'as is' I can modify one to make it work.) Michael Mattias Tal Systems, Inc. Racine WI [EMAIL PROTECTED] - Original Message - From: Fody, Kenneth W. <[EMAIL PROTECTED]> To: 'William J. Kammerer ' <[EMAIL PROTECTED]>; 'WEDi/SNIP ID & Routing ' <[EMAIL PROTECTED]> Sent: Friday, March 29, 2002 1:01 PM Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? > William: > > I agree that the lack of standard Provider IDs is a problem. However, if > the suggestion is that the industry ought to embrace the DUNS number (or any > other number) as an unofficial standard, then I would object to that concept
Re: Payers sure do like proprietary provider IDs! Do providers feel the same way?
Actually, in the WEDi/SNIP ID & Routing group, we're merely concerned with the manner in which entities are identified in the ISA interchange header (and perhaps the GS) segment for routing. As Rachel said yesterday, "the focus [of our group is] on the 'functional use' of the identifier in the ISA as the key to discovering the detailed EDI addressing information." Sometimes we do talk about the problems with the lack of standard identifiers (especially for providers) in the application transaction sets, but it's not in our charter to solve that big, hairy problem! But as it stands, there are only a few ways entities can be identified in the ISA based on the constraints HIPAA imposes on the ISA Interchange ID Qualifier. For providers, it leaves us with only the D-U-N-S (and D-U-N-S with suffix), the Federal Tax ID (or FEIN), or the HIN as acceptable domains for identifiers - if we rule out the 'ZZ' (Mutually Defined) qualifier (the ZZ qualifier is usually used for payer-assigned provider IDs, which are the bane of standardized identification). I assume that once the NPI is in place, there will be no problem getting it added as one of the acceptable ID types in the ISA. But until then, we're still left with problem of how a payer determines the type (D-U-N-S, FEIN or HIN) and value of the ISA receiver ID for a provider. Some of the more recent discussion has suggested taking an identifier the provider is known by to the payer (e.g., the FEIN), and using that ID to search the Registry for the provider's CPP, which in turn contains the provider's preferred ISA ID (and that preferred ID may be the FEIN itself, or another Tax ID, or one of the provider's D-U-N-S numbers). Keep in mind that if the Registry is powerful enough to be searched by any (non-proprietary) ID, then the sender could just blindly stick the FEIN in the ISA receiver ID, knowing full well that a VAN or CH intermediary could search the Registry for the CPP which contains the EDI addresses and ports. The whole concept of a "preferred" ID may give way to a more powerful notion whereby a receiver can be identified in the ISA by any of its known IDs (whose domains or type are allowed by the HIPAA IG). William J. Kammerer Novannet, LLC. +1 (614) 487-0320 - Original Message - From: "Fody, Kenneth W." <[EMAIL PROTECTED]> To: "'William J. Kammerer '" <[EMAIL PROTECTED]>; "'WEDi/SNIP ID & Routing '" <[EMAIL PROTECTED]> Sent: Friday, 29 March, 2002 02:01 PM Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? William: I agree that the lack of standard Provider IDs is a problem. However, if the suggestion is that the industry ought to embrace the DUNS number (or any other number) as an unofficial standard, then I would object to that concept. The problem with that idea is that the release of the final NPI regulation is hanging over us. Enumerating providers is not an easy thing to do. The communication of the new numbers and the process for doing this is time consuming and costly in terms of time, money, and resources. There is significant work involved in creating new provider tables/databases, loading this information, and making sure that all systems process this information correctly. Finally, there will undoubtedly be claim processing problems as an entity migrates from one number to the next. If the industry (or parts) were to move to DUNS and HHS releases an NPI regulation which uses anything other than DUNS (which it is expected they will do), the industry will have to discard all the work to move to DUNS and re-duplicate the effort. There would be no way for the industry to recapture the lost time, effort, and money that it spent moving from today's proprietary IDs to the NPI. The companies I work for have been poised to move to new provider IDs for a number of years now and have been unwilling to pull the trigger for fear that immediately after we do so the HHS reg will come out and the whole thing will be wasted. I would not be surprised if the same is true with other carriers. The best thing for all concerned is for HHS to release the NPI reg and for providers to act quickly in getting their new ID numbers. (Keep in mind that the move to a standard could break down if Providers don't hold up their end by getting these numbers.) The same is true with standard group IDs and payer IDs, for what it is worth. Ken Fody Independence Blue Cross -----Original Message----- From: William J. Kammerer To: WEDi/SNIP ID & Routing Sent: 3/28/02 3:42 PM 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 workin
RE: Payers sure do like proprietary provider IDs! Do providers feel the same way?
Ken, You make some good points about current concerns but unfortunately the federal government is starting to play a bigger part in financing US hospitals. The AHA has lashed out at Medicare for cut backs in reimbursements and they will probably be restored, in the past 10 years 12% of ER's in the US have closed yet ER visits are up 27%(AHA), the USDA using 9/11 concerns has stopped its foreign MD program in rural areas which will hurt rural care, and today some Congressmen announced legislation to help financially strapped rural hospitals under 50 beds(AHA), not to mention all the US hospitals that have either closed or are in the red. The point I am trying to make is that the US medical delivery system is getting more and more dependant on federal subsidies and at some point HHS could start tying these subsidies to compliance of regulations like HIPAA. 'Forcing' them to use national identifiers might be a little easier with a big stick. Outside of healthcare they call this the 800 gorilla. Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 -Original Message- From: Fody, Kenneth W. [mailto:[EMAIL PROTECTED]] Sent: Friday, March 29, 2002 11:02 AM To: 'William J. Kammerer '; 'WEDi/SNIP ID & Routing ' Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? William: I agree that the lack of standard Provider IDs is a problem. However, if the suggestion is that the industry ought to embrace the DUNS number (or any other number) as an unofficial standard, then I would object to that concept. The problem with that idea is that the release of the final NPI regulation is hanging over us. Enumerating providers is not an easy thing to do. The communication of the new numbers and the process for doing this is time consuming and costly in terms of time, money, and resources. There is significant work involved in creating new provider tables/databases, loading this information, and making sure that all systems process this information correctly. Finally, there will undoubtedly be claim processing problems as an entity migrates from one number to the next. If the industry (or parts) were to move to DUNS and HHS releases an NPI regulation which uses anything other than DUNS (which it is expected they will do), the industry will have to discard all the work to move to DUNS and re-duplicate the effort. There would be no way for the industry to recapture the lost time, effort, and money that it spent moving from today's proprietary IDs to the NPI. The companies I work for have been poised to move to new provider IDs for a number of years now and have been unwilling to pull the trigger for fear that immediately after we do so the HHS reg will come out and the whole thing will be wasted. I would not be surprised if the same is true with other carriers. The best thing for all concerned is for HHS to release the NPI reg and for providers to act quickly in getting their new ID numbers. (Keep in mind that the move to a standard could break down if Providers don't hold up their end by getting these numbers.) The same is true with standard group IDs and payer IDs, for what it is worth. Ken Fody Independence Blue Cross -Original Message- From: William J. Kammerer To: WEDi/SNIP ID & Routing Sent: 3/28/02 3:42 PM 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. 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
RE: Payers sure do like proprietary provider IDs! Do providers feel the same way?
William: I agree that the lack of standard Provider IDs is a problem. However, if the suggestion is that the industry ought to embrace the DUNS number (or any other number) as an unofficial standard, then I would object to that concept. The problem with that idea is that the release of the final NPI regulation is hanging over us. Enumerating providers is not an easy thing to do. The communication of the new numbers and the process for doing this is time consuming and costly in terms of time, money, and resources. There is significant work involved in creating new provider tables/databases, loading this information, and making sure that all systems process this information correctly. Finally, there will undoubtedly be claim processing problems as an entity migrates from one number to the next. If the industry (or parts) were to move to DUNS and HHS releases an NPI regulation which uses anything other than DUNS (which it is expected they will do), the industry will have to discard all the work to move to DUNS and re-duplicate the effort. There would be no way for the industry to recapture the lost time, effort, and money that it spent moving from today's proprietary IDs to the NPI. The companies I work for have been poised to move to new provider IDs for a number of years now and have been unwilling to pull the trigger for fear that immediately after we do so the HHS reg will come out and the whole thing will be wasted. I would not be surprised if the same is true with other carriers. The best thing for all concerned is for HHS to release the NPI reg and for providers to act quickly in getting their new ID numbers. (Keep in mind that the move to a standard could break down if Providers don't hold up their end by getting these numbers.) The same is true with standard group IDs and payer IDs, for what it is worth. Ken Fody Independence Blue Cross -Original Message- From: William J. Kammerer To: WEDi/SNIP ID & Routing Sent: 3/28/02 3:42 PM 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. 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 CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute and delete the original message. Please notify the sender by E-Mail at the address shown. Thank you for your compliance.
Re: Payers sure do like proprietary provider IDs! Do providers feel the same way?
I hate to be pedantic (but when I do it, I'm being "precise"), but if you paid for a DUNS, you would pay Dun & Bradstreet, not "DUNS." Aside from that, obtaining a DUNS for your own organization is free: I didn't pay anything to get assigned a DUNS from D & B, and as I explained to Chris Feahr this morning, he can get his DUNS for free by following the procedure I outlined. I think you have to pay $.75 or some other nominal charge to get the DUNS numbers of other organizations (though I, too, have gotten those free when I said the numbers were for "research" - I never pay retail). In any event, you would rarely have to ask Dun & Bradstreet for the DUNS of your trading partner; more often is the case your trading partner would give you his DUNS, telling you that's how he is addressed in the ISA. Everyone knows his own DUNS or Federal Tax ID (by the way, the Federal Tax ID is the same thing as the Federal Employer Identification Number - EIN or FEIN) - which is "shorthand" for saying someone at his own organization (say, the CFO) certainly knows these IDs. Once you have a DUNS, enumerating the DUNS+4 is free, because you do it yourself as described in my e-mail from last night. As a matter of fact, this is a good time for me to do the same. Novannet's DUNS is 07-293-0527. So I'm going to assign some DUNS+4 numbers simply by making up internal 4-digit numbers and appending them to my DUNS: 0729305270001 - Accounts Receivable 0729305270002 - Accounts Payable 0729305270003 - Programming department 0729305270004 - Columbus warehouse (my garage and mud-room) 0729305270005 - New Jersey Sales office, and 0729305270006 - Novannet mascot: my cat, Snobol. Being a small outfit, I probably won't require the fine-grained detail of a DUNS+4 when asking others to address my EDI portal: you'll just need to put 072930527 in the receiver field (specifying the code for "DUNS" in the Interchange ID Qualifier) and EDI data will get to me. This assumes we have our recommendations in place for the CPP and Registry, and that I've chosen to be identified by my DUNS. By the way, how many other cats have their own DUNS+4 ID? William J. Kammerer Novannet, LLC. +1 (614) 487-0320 - Original Message - From: "David Frenkel" <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Thursday, 28 March, 2002 12:44 PM Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? Chris, You do pay DUNS for every DUNS number but I think the DUNS+4 is free or at least less expensive. I was just making a point that there is more to DUNS number. It would be more appropriate for the government to have a registry but the last time I worked for a government contractor the GSA required you to have a DUNS number. Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 -Original Message- From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]] Sent: Thursday, March 28, 2002 9:02 AM To: David Frenkel; 'WEDi/SNIP ID & Routing' Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? Dave, I think I did see a little discussion of the "DINS+4", but it strikes me as a partially "de-standardized" standard intended to accomplish what you could also do by requesting a unique DUNS for every department, plan, or incoming message portal in your company. D&B might not condone this, however... preferring to have only one unique DUNS for each identifiable business enterprise. But it doesn't sound like they really support or even acknowledge the "DUNS+" hack either. The govt. could render this moot by getting off its butt and creating a national registry of (tax-paying) business organisms with some sort of unique identifier. Without the full cooperation of a company like D&B and an agreement to support the ID-system the way people want to use it, it strikes me as risky to recommend it as a primary communication identifier for healthcare EDI. If we were going to lean on someone to help support a national business ID registry, it may as well be the fed. govt. -Chris
RE: Payers sure do like proprietary provider IDs! Do providers feel the same way?
Chris, You do pay DUNS for every DUNS number but I think the DUNS+4 is free or at least less expensive. I was just making a point that there is more to DUNS number. It would be more appropriate for the government to have a registry but the last time I worked for a government contractor the GSA required you to have a DUNS number. Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 -Original Message- From: Christopher J. Feahr, OD [mailto:[EMAIL PROTECTED]] Sent: Thursday, March 28, 2002 9:02 AM To: David Frenkel; 'WEDi/SNIP ID & Routing' Subject: RE: Payers sure do like proprietary provider IDs! Do providers feel the same way? Dave, I think I did see a little discussion of the "DINS+4", but it strikes me as a partially "de-standardized" standard intended to accomplish what you could also do by requesting a unique DUNS for every department, plan, or incoming message portal in your company. D&B might not condone this, however... preferring to have only one unique DUNS for each identifiable business enterprise. But it doesn't sound like they really support or even acknowledge the "DUNS+" hack either. The govt. could render this moot by getting off its butt and creating a national registry of (tax-paying) business organisms with some sort of unique identifier. Without the full cooperation of a company like D&B and an agreement to support the ID-system the way people want to use it, it strikes me as risky to recommend it as a primary communication identifier for healthcare EDI. If we were going to lean on someone to help support a national business ID registry, it may as well be the fed. govt. -Chris At 08:15 AM 3/28/02 -0800, David Frenkel wrote: >D&B use to have a free service you could look up a DUNS number but for >some reason they discontinued this service. I'm sure many of you are >aware that there is what is called a DUNS+ number which is a DUNS number >with a suffix. Some organizations have multiple DUNS+ numbers. I >worked for a large manufacturing organization that had a DUNS+ for every >door in their buildings. You might discuss using DUNS vs DUNS+. > >Regards, > >David Frenkel >Business Development >GEFEG USA >Global Leader in Ecommerce Tools >www.gefeg.com >425-260-5030 > >-Original Message- >From: William J. Kammerer [mailto:[EMAIL PROTECTED]] >Sent: Thursday, March 28, 2002 4:11 AM >To: WEDi/SNIP ID & Routing >Subject: Re: Payers sure do like proprietary provider IDs! Do providers >feel the same way? > >Chris: > >D & B uses the "carrot" of the DUNS number get you to use their eUpdate >service to update your business profile. Since your company is listed, >but you do not know your DUNS. they tell you to call 888.814.1435 >Monday-Friday 8:00AM-6:00PM local time, or go to >https://www.dnb.com/product/eupdate/update1.html to request an eUpdate >logon (which is your DUNS) and password to review your company profile. > >William J. Kammerer >Novannet, LLC. >+1 (614) 487-0320 > >- Original Message - >From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> >To: "William J. Kammerer" <[EMAIL PROTECTED]>; "WEDi/SNIP ID & >Routing" <[EMAIL PROTECTED]> >Sent: Wednesday, 27 March, 2002 10:52 PM >Subject: Re: Payers sure do like proprietary provider IDs! Do providers >feel the same way? > > >William, >I did a little poking around on http://sbs.dnb.com/default.asp and I see >that "Christopher J. Feahr, OD" is listed in D&B''s database... even >correctly listing my two partners, one of whom joined me only a year >ago. But I did not see my DUNS number. How does one discover or get >assigned a DUNS #? I would think it's automatic if you are in the DB as >a "business". >-Chris > >BTW: I do find it extremely annoying as a provider to have to maintain >so many different IDs for myself for different payors. WHAT THE HECK IS >THE HOLD-UP ON THESE NATIONAL IDENTIFIERS FOR BUSINESSES??? I don't see >how this could be controversial of very difficult to implement. > >Christopher J. Feahr, OD >http://visiondatastandard.org >[EMAIL PROTECTED] >Cell/Pager: 707-529-2268 Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
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. 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
RE: Payers sure do like proprietary provider IDs! Do providers feel the same way?
Dave, I think I did see a little discussion of the "DINS+4", but it strikes me as a partially "de-standardized" standard intended to accomplish what you could also do by requesting a unique DUNS for every department, plan, or incoming message portal in your company. D&B might not condone this, however... preferring to have only one unique DUNS for each identifiable business enterprise. But it doesn't sound like they really support or even acknowledge the "DUNS+" hack either. The govt. could render this moot by getting off its butt and creating a national registry of (tax-paying) business organisms with some sort of unique identifier. Without the full cooperation of a company like D&B and an agreement to support the ID-system the way people want to use it, it strikes me as risky to recommend it as a primary communication identifier for healthcare EDI. If we were going to lean on someone to help support a national business ID registry, it may as well be the fed. govt. -Chris At 08:15 AM 3/28/02 -0800, David Frenkel wrote: >D&B use to have a free service you could look up a DUNS number but for >some reason they discontinued this service. I'm sure many of you are >aware that there is what is called a DUNS+ number which is a DUNS number >with a suffix. Some organizations have multiple DUNS+ numbers. I >worked for a large manufacturing organization that had a DUNS+ for every >door in their buildings. You might discuss using DUNS vs DUNS+. > >Regards, > >David Frenkel >Business Development >GEFEG USA >Global Leader in Ecommerce Tools >www.gefeg.com >425-260-5030 > >-Original Message- >From: William J. Kammerer [mailto:[EMAIL PROTECTED]] >Sent: Thursday, March 28, 2002 4:11 AM >To: WEDi/SNIP ID & Routing >Subject: Re: Payers sure do like proprietary provider IDs! Do providers >feel the same way? > >Chris: > >D & B uses the "carrot" of the DUNS number get you to use their eUpdate >service to update your business profile. Since your company is listed, >but you do not know your DUNS. they tell you to call 888.814.1435 >Monday-Friday 8:00AM-6:00PM local time, or go to >https://www.dnb.com/product/eupdate/update1.html to request an eUpdate >logon (which is your DUNS) and password to review your company profile. > >William J. Kammerer >Novannet, LLC. >+1 (614) 487-0320 > >- Original Message - >From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> >To: "William J. Kammerer" <[EMAIL PROTECTED]>; "WEDi/SNIP ID & >Routing" <[EMAIL PROTECTED]> >Sent: Wednesday, 27 March, 2002 10:52 PM >Subject: Re: Payers sure do like proprietary provider IDs! Do providers >feel the same way? > > >William, >I did a little poking around on http://sbs.dnb.com/default.asp and I see >that "Christopher J. Feahr, OD" is listed in D&B''s database... even >correctly listing my two partners, one of whom joined me only a year >ago. But I did not see my DUNS number. How does one discover or get >assigned a DUNS #? I would think it's automatic if you are in the DB as >a "business". >-Chris > >BTW: I do find it extremely annoying as a provider to have to maintain >so many different IDs for myself for different payors. WHAT THE HECK IS >THE HOLD-UP ON THESE NATIONAL IDENTIFIERS FOR BUSINESSES??? I don't see >how this could be controversial of very difficult to implement. > >Christopher J. Feahr, OD >http://visiondatastandard.org >[EMAIL PROTECTED] >Cell/Pager: 707-529-2268 Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
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 -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Wednesday, March 27, 2002 5:44 PM To: WEDi/SNIP ID & Routing Subject: Re: Payers sure do like proprietary provider IDs! Do providers feel the same way? 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." <[EMAI
Re: Payers sure do like proprietary provider IDs! Do providers feel the same way?
Chris: D & B uses the "carrot" of the DUNS number get you to use their eUpdate service to update your business profile. Since your company is listed, but you do not know your DUNS. they tell you to call 888.814.1435 Monday-Friday 8:00AM-6:00PM local time, or go to https://www.dnb.com/product/eupdate/update1.html to request an eUpdate logon (which is your DUNS) and password to review your company profile. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 - Original Message - From: "Christopher J. Feahr, OD" <[EMAIL PROTECTED]> To: "William J. Kammerer" <[EMAIL PROTECTED]>; "WEDi/SNIP ID & Routing" <[EMAIL PROTECTED]> Sent: Wednesday, 27 March, 2002 10:52 PM Subject: Re: Payers sure do like proprietary provider IDs! Do providers feel the same way? William, I did a little poking around on http://sbs.dnb.com/default.asp and I see that "Christopher J. Feahr, OD" is listed in D&B''s database... even correctly listing my two partners, one of whom joined me only a year ago. But I did not see my DUNS number. How does one discover or get assigned a DUNS #? I would think it's automatic if you are in the DB as a "business". -Chris BTW: I do find it extremely annoying as a provider to have to maintain so many different IDs for myself for different payors. WHAT THE HECK IS THE HOLD-UP ON THESE NATIONAL IDENTIFIERS FOR BUSINESSES??? I don't see how this could be controversial of very difficult to implement. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
Re: Payers sure do like proprietary provider IDs! Do providers feel the same way?
William, I did a little poking around on http://sbs.dnb.com/default.asp and I see that "Christopher J. Feahr, OD" is listed in D&B''s database... even correctly listing my two partners, one of whom joined me only a year ago. But I did not see my DUNS number. How does one discover or get assigned a DUNS #? I would think it's automatic if you are in the DB as a "business". -Chris BTW: I do find it extremely annoying as a provider to have to maintain so many different IDs for myself for different payors. WHAT THE HECK IS THE HOLD-UP ON THESE NATIONAL IDENTIFIERS FOR BUSINESSES??? I don't see how this could be controversial of very difficult to implement. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
Re: Payers sure do like proprietary provider IDs! Do providers feel the same way?
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
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 -Original Message- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Tuesday, March 26, 2002 11:47 AM To: WEDi/SNIP ID & Routing Subject: Payers sure do like proprietary provider IDs! Do providers feel the same way? Doug Renshaw was kind enough to respond to my pleas from 15 March for information on how folks currently (or will) handle the ISA and GS for routing standard transactions; he has graciously agreed to let me pass on Highmark's plans as grist for discussion. Other than Doug, only Tim Collins and John Bristor have responded. Tim divulged some information on how Kentucky Medicaid might be handling IDs, and John Bristor shared what appears to be some kind of Medicaid EOB with strange and wondrous proprietary IDs. At this rate, I don't have too much to work from: I hate to nag, but with the hundreds of people on this list, surely some more folks could throw information my way so Ron Bowron and I can do a "proper" requirements analysis. Doug said that Highmark will require that its NAIC code (54771) be submitted as the Receiver ID in the ISA. In the GS, he will require the NAIC of the payer that the transaction applies to, which could be that of Highmark or several other associated payers. NAIC codes are 5 characters, and the GS receiver ID can have a payer-defined 3 character suffix applied to the NAIC. In some cases, they will use a Highmark-assigned alpha suffix to manage internal routing requirements of stuff within the same payer. For the Sender ID in both the ISA and GS, Highmark requires the use of a proprietary trading partner ID. For transactions coming from a Clearinghouse, they'll have a trading partner ID for the clearinghouse which will be tied to individual providers. Also, Highmark requires a logon and password to connect to its network for sending and receiving EDI files. Highmark is considering use of the Internet to replace its dial-in network, but use of a logon and password would still be required. Highmark will only accept standard transactions, and only for a set list of payers who are in the Highmark "family". If a provider attempts to send transactions to payers not on Highmark's list, they will be rejected. Highmark is not attempting to offer providers a "portal" for submission of their claims to any and all payers - only a means of getting claims directly to itself and several of its subsidiaries. Doug does agree with my belief (by reading the NPRM) that payers will have to offer providers a direct "portal," or else will have to contract with a clearinghouse to collect standard transactions for them. As for Highmark's use of NAIC suffixes in the GS, they spell out some specific uses for particular transactions as required for internal routing and processing purposes. Specifically, Highmark will require a "V" on vision claims, and for institutional claims, they will require a "W" if the institution is in its Western Region and a "C" if in its Central Region. Doug recognizes that NAIC codes are not a solution that works for all health plans, and that Highmark may need to change its requirements if and when a national plan ID is established. Likewise, according to Tim Collins, Kentucky Medicaid now has plans to re-assign proprietary provider IDs in anticipation of HIPAA . These IDs are "intelligent," in that the 10-digit number used on the ISA denotes the type of submitter (e.g., Medical Practice, Software Vendor or Billing agent), further qualified by the type of institution on whose behalf
