Marcallee Jackson told us "[e]ach healthcare clearinghouse maintains a list of payer ID's. These ID's are sometimes designated by the clearinghouse, sometimes by the clearinghouse's trading partner and sometimes by the payer. I believe its this code that is commonly sent in the ISA field."
Isn't our problem made easier if the payer tells everyone what its own name or ID is, constrained by the allowable qualifiers in the ISA Interchange ID Qualifier? In the absence of the National Plan ID, we should allow for a payer being identified whatever ID it prefers - Anthem might prefer the D-U-N-S and Highmark the NAIC. Some payers might have two or more D-U-N-S, any of which may be acceptable. Likewise, some providers will identify themselves by the HIN, others by the FEIN. But it does no service to interoperability if a provider, using HIPAA standard transactions, has to make a determination like "Payer 'A' is on CH 'B', who demands that the payer be identified by 'C' in the ISA, except on Thursday, when it must be 'D'." Along the same lines, do we want to banish use of the "ZZ" (Mutually Defined) qualifier, which - as Kepa has pointed out - is often used to specify an ID given to the provider by the receiving payer? William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Marcallee Jackson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]>; "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Monday, 21 January, 2002 06:05 PM Subject: RE: Payor identification codes for 837I While a provider might bill several dozen plans over the course of a year it's normally fewer than 20 that make up 90% of the volume. Even for a large provider in an urban setting. Depending on the number of hoops a plan forces a provider to jump through in order to bill electronically, providers may choose to bill low volume payers on paper. For example, if a provider has to sign a payer specific trading partner/EDI agreement, it's less likely they'll bill electronically to a payer they'd only be sending a couple hundred claims a year. Each healthcare clearinghouse maintains a list of payer ID's. These ID's are sometimes designated by the clearinghouse, sometimes by the clearinghouse's trading partner and sometimes by the payer. I believe its this code that is commonly sent in the ISA field. Marcallee Jackson Long Beach, CA 562-438-6613
