In regards to the second question: Regardless of whether the NPI is
implemented or not, for the billing and pay-to providers (in the claim
transaction) the tax ID is always required. If it's pre-NPI, the
tax ID is carried in the NM1. If it is post-NPI it is carried in the REF.
The use of the secondary identifier may continue even
after the NPI is finalized. I've brought this up with HHS, but until
the NPI is published, they can't really comment. As a payer, we have
IRS responsibilities to report income on a 1099. In the proposed
NPI, there was a possibility that we would not be able to link the NPI
to a FEIN because we would have limited access to the information.
We also need to use the FEIN to match against provider contracts.
We hope this is corrected in the final rule to allow payers to get access
to the FEIN, because if it isn't it decreases the value of a NPI.
But if it isn't, I would assume we could require that the FEIN go in the
secondary identifier? Any comments on how anyone is addressing this?
>>> [EMAIL PROTECTED] 10/18/01 01:42PM >>>
The National Provider Identifier (NPI) is expected to become the identifier
for health care providers. It has not yet been adopted as the
standard (that is, the Final Rule has not yet been published). Therefore,
implementation of the NPI is down the road. In the meantime, until
there is a standard provider identifier in place, a "secondary" identifier
is required in order to identify the billing provider (as well as other
providers on the claims). Most likely the identifier currently used
to identify the billing provider (UPIN, BC or BS Number, PPO number, etc.)
when billing a particular health plan is what would be used.
>>> [EMAIL PROTECTED] 10/18/01 01:55PM >>>
Group,
I have a question relating to the Billing Provider Secondary Identification
data element on the 837 Institutional transaction:
Within the notes section (page 82 of 837 - Institutional Implementation
Guide) there is a statement that reads:
"[the billing provider secondary identification] is required when a
secondary identification number is necessary to identify the entity."
My question is this:
Who makes that determination? What dictates that a secondary identification
number must be sent?
Any insight is appreciated.
Thanks,
Paul
__________________________
Paul V. Costello
Senior Consultant
CGI (formerly IMRglobal Corp.)
3100 Zinfandel Drive, Suite #250
Rancho Cordova, CA 95670
Phone: (916) 631-7645 ext. 30
Fax: (916) 631-7647
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