Ron, It doesn't sound too technically challenging to maintain a central registry of Globally Unique Provider ID Numbers... but obviously, there are some major unresolved problems preventing us from doing this. Is the govt. still pursuing this? Why doesn't the existing Medicare UPIN solve this problem?
I agree with you that the AMA-like entities are well positioned to fill some of these needs for providers. I have been discussing an EDI standards leadership role with the AOA (American Optometric Association) for a little over a year now. In vision we also have to consider the Academy of Ophthalmology, Vision Council of America (a manufacturer-driven trade assn.).... plus the AMA as possible candidates for this. As much as I'd like to see one giant "content committee" for healthcare, with sub-sections for vision, dental, chiropractic, etc. to ensure true industry-wide harmonization of data content and connectivity issues... the creation of such an entity seems unlikely any time soon. Since this providerID issue is intimately involved with the work of this group (EDI addressing and message routing, for the benefit of the people I'm copying), shall we create a requirements list for just that one area? Then maybe propose it to these associations? Problem 1: Who pays for maintenance and distribution? If the Association absorbs this cost, will they be willing to do it for non-members? (maintenance costs for a large list may not be much greater than for a small list.. so really any of these groups could consider doing it for all of health care.. but that raises "political" issues among the doctors) Problem 2: What will incentivize the providers to all sign up for ID numbers? Maybe payors refusing claims without them would suffice, but payors will not all agree to do it... particularly if the "problem" is only that the provider has to maintain a million unique "identities". We are going to face similar challenges for "standard answer lists" for all the LOINC codes that will have to be created for all the attachments... who is going to maintain and distribute these? Eventually, we'll have to bite the bullet and create that "healthcare content and connectivity committee" -Chris At 11:10 AM 2/15/02 -0700, Ronald Bowron wrote: >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. Christopher J. Feahr, OD http://visiondatastandard.org [EMAIL PROTECTED] Cell/Pager: 707-529-2268
