HIPAA Identifiers

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HIPAA Identifiers

• Richard Landen, BCBSA
• WEDI SNIP Solutions Conference
• Monday, November 12, 2001
• Wyndham Hotel, Orlando, Florida

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Todays View

• Overview
• Status
• Highlights
• Discussion
• NPI Issues and Educational Needs
• Health Plan ID Issues

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HIPAA Standard Identifiers Overview

• HIPAA Legislation named 4 standard identifiers
• National Provider Identifier (NPI)
• Employer Identifier (EIN)
• National Health Plan Identifier
• Individual Identifier

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HIPAA Standard Identifiers Status

• National Provider Identifier (NPI)
• NPRM May 5, 1998
• Expecting significant changes
• Awaiting final rule 4Q01/1Q02?
• Awaiting Infrastructure (NPS)
• Employer Identifier (EIN)
• NPRM June 16, 1998
• Non-controversial
• Awaiting final rule 4Q01/1Q02?

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choice.
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HIPAA Standard Identifiers Status

• National Health Plan Identifier
• HCFA (CMS) issue paper 1997/1998
• Awaiting NPRM 1Q or 2Q 2002?
• Standard Individual Identifier
• On indefinite hold by Congress
• Read that permanent hold unless public sentiment
  changes

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Employer ID (EIN) Highlights

• Internal Revenue Service EIN
• Infrastructure and assignment rules established
  and in place
• Employer ID number does note equate to Group
  Number for claims

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Individual Identifier Highlights

• Compelling opposition to concept
• No compelling need demonstrated alternatives
  available
• Wait-and-see about HIPAA Privacy
• ANSI HISB list of candidates
• SSN or SSN with check digit is leading contender

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NPI and NPS
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National Provider Identifier (NPI) Highlights

• NPRM presented two alternatives
• a) Individual, Group and Organizational NPIs
• b) Individual and Organizational NPIs
• WEDI/PAG recommended b)

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National Provider Identifier (NPI) Highlights

• Personal NPI
• 1 and only 1
• Other-than-personal NPI(s)
• 0, 1 or gt1
• No business rules yet
• PAG provider choice based on business need
• Industry split on usage

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National Provider Identifier (NPI) Highlights

• NPRM had 8 digit alphanumeric, including check
  digit
• WEDI/PAG recommended 10 digit numeric, with check
  digit

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National Provider Identifier (NPI) Highlights

• NPRM presented alternatives for administration
• WEDI/PAG recommended single administrator under
  federal auspices
• NPRM options Key WEDI/PAG recommendations
• NPS should capture one practice address and one
  mailing address for each provider
• NPS should not assign a location code to each
  practice address in a health care providers
  record
• NPS should not link the NPI of a group provider
  to the NPIs of the individual providers who are
  members of the group

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National Provider Identifier (NPI) Highlights

• NPRM requested recommendations for funding
  NPI/NPS
• WEDI/PAG recommended federal funding with
• no fees to obtain/update an NPI
• reasonable user fees

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NPIs National Provider System (NPS)
Infrastructure Outline

• CMS and contractor
• Enumeration
• Initial
• Maintenance, Additions and Updates
• Database
• Content
• Verification level
• Dissemination access and access levels
• Funding

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NPI Outstanding Issues

• Personal NPI
• PAG Other than mechanics of issuance, no major
  outstanding issues

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NPI Outstanding Issues

• Other-than-personal NPI
• 1 or gt1?
• No consensus on 1
• How to minimize proliferation, but allow for now
• Vision toward 1 in future HIPAA

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NPI Outstanding Issues

• Note this part of the session is intended to be
  semi-interactive your opinions welcome.
• Other-than-personal NPI(s)
• Regional groups perspectives?
• Providers current expectations?
• Health Plans current expectations?
• Practice management vendors?
• Clearinghouses?
• Other?
• Straw polls, if helpful

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NPI Education PAG Discussion, 12/2000

• NPI application process needs to be clear
• Providers have to know how to use the NPI and why
  they should use it
• Coordinate and standardize language in outreach
  materials, so that materials from different
  sources will not create conflicting
  interpretations

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NPI Education PAG Discussion, 12/2000

• Outreach mechanisms for education and
  implementation, e. g.
• Licensing agencies
• Associations (i.e. ADA, AMA, MGMA, etc.)
• Health Plan Provider Relations
• Frequently Asked Questions (FAQs)
• Seminars, educational materials
• HCFA press release upon Final Rule
• Medicare Carriers and Intermediaries send letters
  to providers

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NPI Education and Implementation Discussion

• Note this part of the session is intended to be
  interactive you do the talking now!
• Educational needs and strategies?
• Implementation needs and strategies?

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Health Plan Identifier
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National Health Plan Identifier Highlights

• HCFA (now CMS) Issues Paper 1997/1998
• 9 digit numeric, including check-digit
• IDs for Parent and for Subsidiaries
• Includes concept of EDI addresses

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National Health Plan Identifier Highlights

• NPRM expected 2002
• First quarter or first half?
• Some speculation 12/01
• Anticipate 60-day public comment period
• WEDI ID PAG will convene for review/comment
• Meanwhile, IGs handle current IDs

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Health Plan ID Heads Up Issues Discussion

• Note this part of the session is intended to be
  interactive you do the talking now!
• Issuance
• Assume CMS/contractor similar to NPI/NPS?
• Other options?
• Uses
• Routing

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Questions?

• E-mail additional questions/comments to
• Richard.Landen_at_bcbsa.com
• Richard W. Landen, Senior Representative
• BCBSA, National Electronic Standards
• [phone]