Part of any disagreement [on the scope of Identifier discussion] may be due to confusion (on my part) with the charter of the Identifiers Subgroup (the "ID" of WEDi/SNIP ID & Routing) - not an easy confession to make considering I got "volunteered" to be a co-chair of the sub-group at the Seattle meeting, along with Zon Owen!
I may have been asleep at the wheel, and didn't really notice that the scope of the Identifiers subgroup seems much larger than I originally thought. The 6010 Project Organization paper shows this subgroup will "...write implementation guidelines for use of identifiers in standard EDI transactions. It will address the problems for implementation prior to the introduction of national standard identifiers, entities potentially not included in the national identifier programs, transition to national identifiers, and use of national identifiers." This seems like an overly broad mission, especially since we're mostly concerned with interoperable guidelines for "discovering" EDI addresses to use in the routing of standard EDI transactions. Reading the Identifiers subgroup's scope, I'm not surprised people would think we're going to get into the nitty grittty of using identifiers for providers, payers and contracts within application transaction sets! I have no objection to looking at this interesting problem or writing it up in our white paper (which would consist of just copying and pasting from Kepa's Identifier myths), but this is really a topic better served by the overall WEDi/SNIP Business Issues SWG. If there's no strong objection, Peter Barry and I advocate restricting the scope of the Identifiers sub-group to investigating identifiers "as they're used to assist in the routing of standard transactions - i.e., when they're used in the ISA receiver field." One scenario, relevant to Peter's other work, is how the provider will use the number on the patient's insurance card to "discover" the EDI address of the payer to whom claims and eligibility requests should be sent. The insurance card will contain the card issuer number which includes the (National) plan ID; using our recommendations, this Plan ID would be the key to searching for the EDI address(es) of the ultimate payer (or CH or repricer). As it is - even without "mission creep" in the Identifiers subgroup - we're still probably stepping on the toes of other workgroups within AFEHCT-WEDI Health Care Communications Security and Interoperability project (in the areas of security and packaging interchanges). Peter Barry sent out an announcement Friday re: the AFEHCT-WEDI Interoperability effort; the listserv for the AFEHCT-WEDI project is now set up. If you would like to join its listserv, go to www.afehct.org, and follow the instructions to join the "Interop" listserv. After this new AFEHCT-WEDI project starts up, it will be easier to coordinate and "liaise" with them. See Document 1100 Project Organization at the WEDi/SNIP ID & Routing web page at http://www.novannet.com/wedi/. William J. Kammerer Novannet, LLC. +1 (614) 487-0320 ----- Original Message ----- From: "Rachel Foerster" <[EMAIL PROTECTED]> To: "'WEDi/SNIP ID & Routing'" <[EMAIL PROTECTED]> Sent: Sunday, 17 February, 2002 02:29 PM Subject: RE: Number of IDs assigned to a provider I'm not sure that I agree at all with the assertion below that "identifiers are of interest .... only as they may be used in the ISA sender/receiver fields." I'd much prefer to get feedback from payers and providers on what their needs are on this issue....especially in light of the fact that it appears that it's not at all uncommon for a provider to have to send a claim to a payer selecting from more than a single address. What's the sentiment from the payers and providers (I do hope there are a few!) on this list? Is there consensus to limit the scope of the discussion of identifiers - issues, challenges, needs/requirements - to only the ISA segment? Rachel Foerster Rachel Foerster & Associates, Ltd. Phone: 847-872-8070 -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Sunday, February 17, 2002 11:46 AM To: WEDi/SNIP ID & Routing Subject: Re: Number of IDs assigned to a provider One reason Kepa appears to be such a prolific writer is that he keeps on re-using the same old (but good) stuff - cutting and pasting from here to there. So, without his permission, I'm reproducing his Identifier Myths #47 through 49, from last summer on HIPAAlive, which give more background on the "Multiple Personality Disorder." See the WEDi/SNIP ID & Routing web page at http://www.novannet.com/wedi/ - look for "Kepa's Identifier Myths #47 - #49." Identifiers are of interest to us here in the WEDi/SNIP ID & Routing group only insofar as they're used to assist in the routing of standard transactions - i.e., when they're used in the ISA receiver field. The MPD only affects identification of the provider (and the contract) in the claims ensconced within the X12 transaction. I have not seen any convincing evidence that a provider needs (or wants) multiple IDs to identify his "EDI Server" or "front door" or "inbox" (to use Chris Feahr's terms). As a matter of fact, I can easily imagine a single 837 containing claims (intended for a particular payer) which pertain to any number of contracts or provider IDs - which one do you use for the provider's ISA EDI Identifier used in the ISA? Remember: it has to be one of the ID domains allowed by the HIPAA IGs, which kind of boils down to the DUNS, HIN or EIN for providers. Payers already seem to know the providers' EINs - certainly those could be used. There's no reason for a provider to have to define a multitude of EDI addresses for each payer-proprietary provider no. combination - for most providers, indeed, all EDI will end up at the same "front door." Let's not solve OPPP (other people's programming problems). William J. Kammerer Novannet, LLC. +1 (614) 487-0320
