Unique Health Identifiers Implementation Team

1
Unique Health Identifiers Implementation Team
2
Charge

• Recommend Standard Unique Health Identifiers
  (including allowed uses)
• Individual
• Employer
• Health plan
• Health Care Provider

3
Individual Identifier

• Current Activities
• Analysis of proposals in ANSI/HISB inventory
• Use of criteria from American Society for Testing
  and Materials Standard Guide for Properties of a
  Universal Health Care Identifier
• Evaluation of SSN by SSA
• Evaluation of Postal Service as Trusted Authority

4
Individual Identifier

• Current Thinking--Eliminate consideration of
• Unenhanced, unverified SSN
• Biometric identifier proposals
• Identifier based on existing medical record
  number plus practitioner prefix

5
Individual Identifier

• Current Thinking--Continue consideration as
  identifiers
• Enhanced SSN, as proposed by the Computer-based
  Patient Record Institute
• Identifier based on personal immutable properties
• Universal Health Care Identifier (UHID), as
  described in ASTM Guide

6
Individual Identifier

• Current Thinking--Continue consideration as
  supporting technologies
• Directory service, or master patient index
• Public/private key encryption

7
Individual Identifier

• Issues
• Risks, limitations of SSN as a health identifier
• Insufficient documentation of infrastructure for
  other proposals
• Adequacy of current technology to support
  national master patient index (MPI) or
  public/private encryption
• Acceptance by public of a national MPI or
  national health identifier

8
Individual Identifier

• Issues
• Method to positively link individual to his/her
  identifier
• Method to prevent issuance of duplicate
  identifiers
• Medical record linkage vs right to anonymous care
• Costly infrastructure investment likely
• Controversy with any recommendation

9
Employer Identifier

• Current Activities
• Coordination with Enrollment/Disenrollment, First
  Report of Injury, Premium Payment transactions
• Current Thinking
• Recommendation of Employer Identification Number
  (EIN)

10
Employer Identifier

• Issues
• EIN is not unique to the employer--Is this a
  problem for health transactions?
• Some sole proprietors do not have an EIN--Would
  they be required to obtain an EIN for health
  transactions?
• Would health transaction uses of EIN require
  legislative or regulatory change?

11
Health Plan Identifier

• Current Activities--PAYERID to be proposed
• 9-position numeric, including 1 check digit
• No intelligence in number
• Can enumerate 100 million health plans and
  employers that offer funded and unfunded health
  benefits

12
Health Plan Identifier

• PAYERID System Features
• Registry of business information about the entity
• Electronic phone book containing names of
  entities and their PAYERIDs
• Data base of information needed to route health
  care transactions electronically
• Issue--High-level vs detailed enumeration

13
Provider Identifier

• Current Activities--National Provider Identifier
  (NPI) to be proposed
• 8-position alphanumeric, including 1 check digit
• No intelligence in number
• Can enumerate 20 billion providers

14
Provider Identifier

• System Features
• Data validation (SSN, address, etc.)
• Search/match for duplicate providers
• Query/report generation--national data base

15
Provider Identifier

• Issues
• Enumeration options
• Provider practice addresses and location codes
• DHHS OIG Sanction Data