Hi Jan If you have a few moments next week could you call me to talk about your HIPAA assessment tool. I am hearing wonderful things in the industry about it and would like to talk with you if you have some time available.
Thanks! David Sharp, Ph.D. Maryland Health Care Commission 410-764-3578 -----Original Message----- From: Jan Root [mailto:[EMAIL PROTECTED]] Sent: Friday, October 19, 2001 9:16 AM To: [EMAIL PROTECTED] Subject: Re: Secondary Billing Provider Identifier << File: Card for Jan Root >> Yes, we are saying the same thing using different words. At least until the NPI comes out in final form (and there are seveal key unanswered questions at this point about the NPI), payers can mandate that providers send secondary identifiers beyond the tax ID. This is a business decision on the part of the payer. A business mandate means "I won't pay you unless you send this ID". And yes, a payer can mandate that a provider send a specific ID. It doesn't do United HealthCare much good to get a BC provider identifier, United doesn't keep track of BC's provider Ids. United want's its specific identifier. BC wants its identifier and so forth. j Paul Costello wrote: > I understand that the NPI will be the mandated data element for the primary identifier for the billing provider, but until then, billing providers can use their Employer Identification Number (Code = 24) or their social security number (Code = 34) as their primary identifier. > > The IG also requires a secondary identifier in those cases where "a secondary identification number is necessary to identify the entity." > > Who makes that determination? > > To re-state my original question: since payers will either receive the billing provider's EIN or SSN on an 837, can the payers also mandate that billing providers send a secondary identifier? If so, can payers mandate which secondary identifier must be sent (e.g. BC number , BS number, etc.)? > > Thanks Again, > Paul > > >>> [EMAIL PROTECTED] 10/18/01 02:58PM >>> > 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 > E-Mail: [EMAIL PROTECTED] > > ***Confidentiality Notice*** > Proprietary/confidential information belonging to CGI (formerly IMRglobal) > may be contained in this message. If you are not a recipient indicated in > this message (or responsible for delivery of this message to such person), > or you think for any reason that this message may have been addressed > to you in error, you may not use or copy or deliver this message to anyone > else. 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