Rachel, The issue regarding which Provider ID to use and when has been an issue that has been on-going since I can remember (I still consider myself young). Because of issues such as state licensing, Medicaid, Medicare and Commercial carriers have all attempted to create a means of determining if the physician is licensed as part of their authorization process, thereby reducing fraud and abuse. This leads to each entity creating an identifier that they could use for such purposes. Fortunately, many of the larger commercial payers accept the Medicare or Medicaid physician identifier, but not all, and not all providers handle Medicare or Medicaid patients; and that's the problem. As we know, it was the lack of standards that lead the HIPAA regulation to included the Unique Provider Identifier requirements. Interestingly enough, the free-market economy may still prevail. Below is a link to an article of how the AMA is attempting to helping the provider community (and their membership roles). http://www.ama-assn.org/ama/pub/article/1616-4573.html
While this doesn't directly implement the UPIN, it does establish a foundation for enforcing trusted identification. I can see the day where the AMA will be a VAN for internet connectivity between the Providers, Patients and the Payers as part of their membership fees. While I'm not advocating any specific organization or it's business models, I do believe the AMA would have significant understanding of the issues specific to the provider community. Do you know if we have any representation from the AMA on this group? Ronald Bowron >>> Dave Minch <[EMAIL PROTECTED]> 02/14/02 05:11PM >>> Rachel, Yes. The prime example would be Medicare - each of our entities has a Medicare provider number, and yes, we must use that number when billing Medicare. Ditto MediCal. I inquired with a couple of our larger business offices, and their response was yes for many of the health plans, but not as frequently for the fee-for-service payers (to the extent that any still remain...). If we had 5 or 6 plans for a given payer, then, yes, we could have as many IDs for that payer, although normally we don't. For many payers, we have a single identifier for each business entity, regardless of the number of plans. Dave -----Original Message----- From: Rachel Foerster [ mailto:[EMAIL PROTECTED]] Sent: Thursday, February 14, 2002 10:38 AM To: WEDi SNIP 4 (E-mail 3) Subject: Number of IDs assigned to a provider I'm forwarding the message below to this list since it contains what I believe is extremely relevant information regarding identifiers, the number of identifiers a given provider may have with a given payer, and thus the implications for requirements/solutions for identifiers. I've deleted the non-relevant portions of the message. My question to this group: is the assignment of several identifiers to a given provider common business practice? Rachel Rachel Foerster Rachel Foerster & Associates, Ltd. Phone: 847-872-8070 -----Original Message----- From: Hooser, Larry [ mailto:[EMAIL PROTECTED]] Sent: Wednesday, February 13, 2002 1:24 PM To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] ; [EMAIL PROTECTED] Subject: RE: Web authentication for HIPAA Thanks for the thoughtful response. Pretty much the same principles I have. Further comment: We have possibly 25,000-40,000 providers needing access with an average of 4-6 ids each; that's 200,000+ users right off the bat. Requiring tokens, readers, cards, etc. in that fluid (staff coming and going, moving, etc.) environment would be costly, cumbersome, overhead intensive (as any "client" solution is), and very challenging - in my view; and I don't believe the software-only certificates add much or any value beyond strong, enforced passwords.
