I'm working on the Identifiers Working Paper for WEDI/SNIP with Ron Bowron, and we're trying to put together real examples of Identifiers as used in the ISA for routing. I have plenty of NAIC insurance company codes, and D-U-N-S numbers for hospitals and clinics, and even a few tax IDs, but have little in the way of HIN (Health Industry Number) examples.
Working with real examples helps in two ways: (1) it holds one's attention better to use real examples, instead of saying D-U-N-S xxxx for Hospital Y, and (2) if you have real good luck finding, say, a D-U-N-S for every practice and hospital you may have ever been interested in or heard about, perhaps it means D-U-N-S has great coverage and we could constrain the routing ID for providers to always be a D-U-N-S for consistency and simplicity. This is what RosettaNet and GISB have done: all trading partners must be identified with their D-U-N-S. Some examples follow, with nothing changed to protect the innocent. The punctuation typically used to make the printed ID more readable - consisting of dashes in the D-U-N-S and the FEIN - would not be present in EDI or our registry. D-U-N-S: 04-643-0013 - CHILDREN'S HOSPITAL, COLUMBUS , OH 07-164-3589 - RIVERSIDE METHODIST HOSPITAL,COLUMBUS , OH Federal Tax IDs (FEINS): 23-2229683 - Aetna Inc. 61-0647538 - HUMANA INC. 95-4505291 - UCLA Orthopaedic Surgery Medical Group NAIC: 68241 - Prudential 60054 - Aetna 54771 - Highmark HCFA Carrier (Medicare) 16360 - Nationwide - Ohio 00880 - SOUTH CAROLINA BC/BS The HIN (Health Industry Number) is kind of tricky to locate. I called HIBCC, the registrar for the HIN, and they wanted $10 for each ID!!! - even though I told them they were just for some examples in a paper. You would have thought they would have been grateful I wanted to mention them at all! I would prefer HIN examples for hospitals, clinics and other providers, so I would appreciate if someone on this list would supply me some. In actuality, if the HIN were going to be used as a routing identifier, the party identifying itself with a HIN would probably know what its own ID was. Here are some examples for the HIN: 52F8TXK00 - BAXTER HEALTHCARE I8IVONE00 - CARDINAL HEALTH INC. 43KEC3K00 - HUMANA HEALTHCHICAGO I noticed that the 835 guide does not have the ABA Routing Identifier listed as one of the permissible codes for the Interchange ID Qualifier in the ISA. Wouldn't the ABA Routing Identifier typically be used as the receiver ID for payment orders (835) to banks? Can you even route a payment order through a clearinghouse (or VAN) to a bank, or do you always have to "hook" up with your bank directly? Clearly, the 835 EOB - containing PHI - should go between the payer and the provider directly, or through a CE like a clearinghouse. Are there even any Value-Added Banks that can handle PHI? ABA Routing Codes for Banks: 071000013 - BANK ONE, NA, CHICAGO 021000018 - The Bank Of New York Knowing what your own "name" is begs the question whether your trading partner can divine the ID you're known by. Imagine the scenario where a physician first encounters a patient. Let's assume Peter Barry's grandiose plans for insurance cards with National Plan IDs comes to fruition: the National Plan ID could be used to search the "National Plan ID database" to come up with, say, the NAIC company code of the payer. From there, the WEDI/SNIP Registry would be searched on the NAIC to come up with the WEDI/SNIP CPP (Electronic Trading Partner Profile) which is used to tell you how to deliver eligibility inquiries and claims to the payer handling the particular plan. Until the advent of the National Plan ID, I suppose the NAIC company code of the payer could appear directly on the insurance card as the "electronic" EDI address for inquiries and claims. But I don't see any way for the provider to use the 270 Loop 2100B (Information Receiver Name) to convey his D-U-N-S to the payer for use in returning the 271 Eligibility Response. If the provider chose to identify himself by D-U-N-S, how would the payer know which ID to use in the response's ISA? This might be what Chris Feahr wanted to know, i.e., how to auto-discover the "return path" back to the provider? Keep in mind that the provider's sender ID in the ISA should probably be directly used only for TA1 and 997 acknowledgements; there must be some other means of figuring out the ID of the provider for application responses since not only is the ISA long gone (discarded by the translator), but prudence would dictate that the ID be derived from the application data (or other data known to the payer) - rather than saving the ISA sender ID. This may not be a problem for the payer in the case of in-network providers (where the payer would have the provider's "preferred" EDI address - the D-U-N-S - on file). But a non-participating provider has to have some means in the 270 transaction to give the payer his preferred EDI ID. The 837 Claim seems to have gone half-way in acknowledging this problem, and provides a way for the provider (or his agent) to send the "Electronic Transmitter Identification Number" (ETIN) to the payer in the 1000A Submitter Name loop. But there's no way to say whether that code is a D-U-N-S, a Tax ID, or a HIN, or whatever - the 837 IG unhelpfully says "Established by trading partner agreement." Like the 270, the 837 does have a way for the provider of telling the payer his FEIN (Tax ID) in the 2010AB Pay-to Provider loop; but even if the provider used the FEIN as his routing ID, there's no definitive way of saying that it *is* the EDI ID (as opposed to just one more ID the provider shares with the payer). Can anyone help out here? Am I the only one who thinks the HIPAA IGs use IDs in kind of a "loosey-goosey" fashion? William J. Kammerer Novannet, LLC. +1 (614) 487-0320
