Thanks for responding. The incoming claims on an 837 are a different animal, because they (can/usually) also come with address, city, state, and Zip/postal code info, which allows us to narrow the search for a match in our provider database.
I agree that, if we don't get a TIN (FI) on the 276, we won't even try to figure it out. Our problem is that a TIN by itself isn't sufficient to identify a specific Provider in many cases. The way our provider data is structured - and I'm assured that this is fairly standard practice in the industry - if multiple physicians are operating in a clinic or hospital, they all bill, and are all listed in our database, under the TIN for the clinic/hospital. We assign a distinct ID code to each individual physician within that clinic/hospital for individual identification. That's the ID number to which we assume the "SV" qualifier refers, and the one that our "real-world-experienced" folks tell us the physicians won't even try to keep up with. The problem apparently gets worse in rural areas, where a single physician may have multiple office locations, each billing under the that physician's name and TIN. In a case like this, we assign a separate ID (we call it a Sub-TIN Sequence Number) for each office location. So if we get a 276 identifying the Provider as J. Smith, TIN #12-3456789 (the TIN for the clinic/hospital in which he provides services), it's not too much of a stretch to think that Acme Memorial Hospital in Metropolis might have more than one J. Smith practicing there, all billing under the TIN for the Hospital. The bottom line is that, unless we can positively identify a specific physician by only a name and TIN, then if we adhere to the current privacy rules, we'll be sending back very few answers. Hal Scoggins SBPA Systems, Inc. (281) 679-7272 x116 -----Original Message----- From: Alex Chernyak [mailto:[EMAIL PROTECTED]] Sent: Tuesday, April 09, 2002 12:31 PM To: [EMAIL PROTECTED] Subject: Re: More 276/277 questions - they just keep surfacing Hi, Hal We expect to receive provider's federal tax id, the same which is on the claim of interest(12 positions). If 276 doesn't send us a "FI" indicator, we send 277 asking to provide the federal tax id(category code R1- request for additional information, status code 128- Entity tax id). So we are not refusing to answer, just need more info. After that we answer only to that provider whose FTId exactly coincides with what is on a claim. Somehow your adjudication system recognises who the provider is. >>> [EMAIL PROTECTED] 04/09/02 12:20PM >>> Folks, Now that we're wading deeper into the 276/277, more questions are surfacing. Hopefully, someone monitoring this listserv can help us address them. I'll post more as I remember them, but the immediate question we have is regarding the information we send back to the originator of the 276 inquiry. There is a large possibility that we will be unable to precisely identify the Provider specified in the 276, since all we have to go on is a name and TIN. This being the case, it is possible that we may find multiple claims that match the information given. When this happens, the 276/277 IG indicates that we should return the status of all claims we find that match the inquiry. But this raises questions about privacy. Our impression is that the IGs are written strictly from a technical perspective, with no consideration of security and privacy concerns. If we send back status info about all matching claims, without being sure of precisely who the Provider is in the inquiry, are we going to be violating some other piece of HIPAA? On a related note; in the NM1 segment for the Service Provider, NM108 offers an "SV" qualifier, with the note, "When the provider does not have a National Provider ID and Payer has assigned a specific ID number to this provider this code is required." We have assigned such an ID number to each provider in our system. While this would help us "nail down" the provider, one of our claims processing trainers asserts that it is unreasonable to expect a provider to keep track of every unique ID number assigned to them by each of the potentially hundreds of insurance plans they deal with. While the IG appears to give us carte blanche - perhaps even demands, if one gets right down to it - to reject any 276 that comes in without that ID included, folks in our office with significant experience assure us that our assigned ID simply won't show up on the 276. So where does that leave us? If we accept the 276 without that ID, since we have, indeed, assigned it, then we are accepting a non-compliant transaction, since the note says that it is "required." But it seems that we will be rejecting 100% of the inquiries we receive, if we stubbornly insist on adhering strictly to the rules. Any thoughts on either of these issues? Hal Scoggins SBPA Systems, Inc. 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